The URL can be used to link to this page

Home My WebLink About15-017CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-SO40 (319) 356-5497 FAX Authorization Number % g5�-1 ~% (Office Use Only) APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) d¢�ore, will result 1h a erlial of the 1q0 r! F' t Middle > Last 1. Name(REQUIRED) �"' _ ,. r:4 M� —�� 2. Mailing Address (REQUIRED) �� 1'j � �.� ��" y -" �" "', 3. Contact Information Yet�(.;tUYFtf:tl� Email:�'��"^(°`°�, �� nCell (REQUIRED) �ec�n r..w - � � Phone: 4. Prior experience in transportation of passengers: "��(•d (Q.��9:.� �.., .�,. � �4;4��a;:':.. .m , 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? p f.5 Type of offense Where d1 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? o wl.�#lam 7. Have you been convicted of any traffic offenses in the last five years? , Type of offense Where When When .. 0 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 1y 0 Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the,jame(s) "k ! k DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CFRTIPtEO DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF„,REVIEW h You must apply for an Individual Department of Criminal Investigation Report (form available upon request). (OVER FOR REQUIRED SIGNATURE AND NOTARY) 09/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a vatic Chaufteurs license number _ L -r) S i.5 6 1 _ . I understand that if I falsely answer any questions in this application, that this application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will be denied. I agree that in making this application. I consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion. to examine any and all records and documents relating to this application, and I further agree that, if a license is granted. to comply at all times with all of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front ni a MCInj Rul rc%) Signature of Applicant ., Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. STATE OF IOWA ) COUNTY OF JOHNSONm,mmm��"� Subscribed and sworn to before me by On this _ a,." --- -� -•- day of I have reviewed this application, DCI report, and the State certified driving record of this applicant and have dste - mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). Signature of Polio Chief or designee l'2 ( // Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at 1cgov.org. Signdtijre of City Clerk or designe Date Taxi cab businesses are required to provide Driver Identification cards. Cards rnust be 8'/z" (width) and 5'/a" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update ClerkrrAXJDRIVMGEAPPL92014ameMed.DDC 09f2014 'all i Wi tt(o IISMARTER �G uRfll"Vl @�I rusrome W ne N ka xF rvux!JumwuuWWFNWµd F LyMY.W 9DIVI c.Wii b ltl`M'.Jrnv�l:�`-.'.:9ryubF:rVO:ll�"Ps PO Bux �w;."04 o Dem MNYa IPo , IIA f'W�I:J' W�rf WJP 4 Plwa rxv ,: 4595 2,44 9124 1 lfkuo.Y 62- 112'r @ 1'= a 115-23tA48T":I wwwxmaacrE;.gKN Namm Brenneman, Seth David Clty/stoW IOWA CITY, IA 522451 Mailing Clty/State: IOWA CITY, IA 52245/925 9',elrtifie;cdbotlrracw^t of Diriliviiiinlg ltcat oir d DL/ID Or 428XX5561 (IA) Clasm D Audit #: 7543676 Issue Date: Expiration Denim 11/08/2018 Endorsements; 3 Restrictiorim Corrective Lenses Date of Birthri 11/8/1983 Customer Or: IID Statuum OL Status. CDS. States. CDS. Cart Statum CDS. Had Staten: Restriction Sepplarnentr History Inferimatlon COINVIctlelne Citation Date ConvicUoea Date ACD iH,n-a-Baan 03/21/7007.... 06/ 19/70_0! - A20 Derelled dudgrnent OWI ;1 414 ..r fail ro Obey 1 raffic Sign/Signal Operating WhIlle1irtanticated Test Ilteftu®all/Teem IPaillaalre V11aliatldee OcC'urT?.n C'o ,._ _.. ,. .... .... ......... „M .e ....... au3r2fli7ivau� Salnctio ne '3 fWcr"Vrve vr;d IRevolWed ACID �:;Y"n'flWR3lYIPXatIVY„rir'M A98 ..�•. PDill gest 11Mallu ile ';,,'w.D I'"�liulslincvtirubw A98 OWT. i est Jdiluulne. 3394935 EXP VAL None None None None t M:er If&IP0 YIhMAI ll 3�4#:�. �®5&Int'y'm iehnson ..°flccr� 1A 3°A.? Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I am the cu Ilan of the records held by the Office of Driver Services, that this Is a true and accurate copy of an official record currently In the custody of said office, and that I have been authorized by the Director of the Iowa Department of Transportation to so certify. In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, -;Iowa this date: - . t'Q iOffice of Driver Services Iowa Dep. of po b�..16. 2015 9:32A Div of Criminal Investigation Uall, I -r. I.V1.) 111VU15111 UILY UIUwF. - �Jtr U1 JOWd Ulty STATE OF IOWA Criminal Higiory Aecqd Check (1) Request Form To. Town Dividall Of CHOW 113YOstigaflon Support Oparallons bureau, r'Flook 219 E. I"' Str*6t Bea MalnesJowa 3031, (515) 725-6066 (515) 735-6080 Fax No. 8 16 1 P. 3/8 ho' )Dq) V. I DMAccountMainber:.. LIS21L� �-- (JwVPu"wq) 1 1 Ronna C9w'V6fyo'wMQ1P City derwes office -Alo P- —WRA"neah .-RWA Clov YA 52240 lehland: Fans 3y9,,.366101 Low4-CrjminqLM or lte�eordCh�eek)Ke�julfiq QDMsa oAy) .AA Of a ioarah of diG of WA Provided.awne and dato ravopled. X6 Iowa Criminal Motozy Record found with DCI Iowa CrWhial.IlLsibryRecord attarh.ed., FP Da id&fs Received Time—Jan.14.-2015-11;04Akt"No.797 �^� �� M.�CIIAN Jan.16. 2015 9:33AM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00799362 NON CONVICTION PAGE 1 OF I DATE PRINTED - 201.5/01/:L6 DCI ii00799'ib tot NAMEo BRENNEMAN,SNTH DAVID DOE SEX RAC HOT WGT EYE HAIR SKU EOE 19831108 M W 60.2 165 ERE BAD FAR IA A'OD'.X:'HIONA'C, IDENTZF:IERS PHOTO AVAILABLEY CCH RECORD *-w 01 ARRESTED 20070321 AGENCY; IA0520400 IOWA CITY UNIV SRC PD CHARGE NO- 01 IA STATUTE IA321J.2 OVER VER WE INT OWI TRK #: IAO01IL01 COURT DISPOSITION AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO- O1 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 OW 078953 CHARGE CLASSi NOR CONVICTION TRK#: SAOO11L01. DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 200'T 061.9 PROBATION lY 200706:1.9 DISCHARGED FROM 20071210 DEFERRED JUDGEMENT AN ARREST WITHOUT DISPOSITION NOT '..f f'.: OF GUILT.{x.D D BY THE IOWAw OF CRIMINAL INVESTIGATION,OF NON—LAWIDENTIFICATION 19 A PUBLIC MCOPD BUT CAN ONLY BE RELEASED TO ENFOACBMSNT AGENCIES AY T148 DCI. IN THZ ABSENCE OF FINGERPRINTS FOR POSITM IDENTIFICATION THIS RECORD BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF R DIVISION OF CRIMINAL INVESTIGATION No. 8161 P. 4/8