The URL can be used to link to this page

Home My WebLink About15-105r CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX IDENTIFICATION NO I�;--)o1; (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday) Failure to complete the "required" information will result in denial of the application First 1_ 1. Name (REQUIRED) n tr' /h t1 5 Middle C /'t l r J Last o k,) 4? % 1,0 z�r7 2. Address (REQUIRED) 7 y I� (�<)� Py] Les r� 1 f n �t de 3. Contact Information (REQUIRED) Email: h Cj nlof i y(A �jG'G f Cell Phone: 3� C` ?5'O ''gi12C (All written communicatiorl sent via email) 4a. Chauffeur's License expiration date (REQUIRED) Z 2 0 (� b. Taxicab Business Name (REQUIRED) _ �� /1 GyA G `? 1�` r 6 ✓ � [7 41 p r 5. Prior experience in transportation of passengers: 'tlrin C C9 C 3 %f�e9-, r 7 T_ _ 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? 11 e Type of offense,Where When FJA (�`-rctv;� (4y iicc-, 15s 7 01 ' ok 0 roll-) V Cir r�d:^ t f ! cW A C/ �/ h-X�_ /f S? What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other V Have you been arrested / charged with any traffic offenses in the last five years? -75 Type of offense VVhara %Artie.. vvhat happened to the char l one) onvi Dismissed Deferred Suspended Plead Guilty Other 8 Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When o en 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please proe nafne(s V `�i'ri "v 3 W DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE TIFI DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVI9W You must apply for an individual Department of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0212015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that ttre issued to me by the Iowa Department of Transportation valid Chauffeur's license number 7 �C 0 j sued on y /rte / Z /Z expiring on & . I understand that if I falsely answer any questions in this application, that this application may 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 authorization to be a taxicab driver 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 of a Notary Public) Signature of Applicant J aw ��-G Date 5-/Z 6 s STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by 1_1t_1 n^, t 4oa L� o, on this _x;11 day of I a S "<_ [mac I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Chauffeur's license (./�` �. 1 _A2 Signat a of Poly hief or designee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. 'Signature of City Clerk or designee Approved application DCI report State certified driving record Website update 5-,,,)7 -is Date ra Office Use Only c-)� clerkOTN IDRIVBADGEAPPLs2o14amended DDC 03/2015 C4610WADOT wvniowadotgov SMARTER I SIMPLER I CUSTOMEF DRIVF: ' < Office of Driver Services PO Box 9204 y Des Morries, IA 50306-9204 Phone: 51.5-244-9124 1.600-532-1121 i Eax: 511,-239-1837 www'Jow:tdot.gov Certified Abstract of Driving Record Inquiry Date: 5/20/2015 DL/ID #: 251CCO152 (IA) Name: Bane, Thomas Daniel Class: D Address: 5038 AMERICAN LEGION RD Audit #: 5992342 None SE Issue Date: 05/18/2012 City/State: IOWA CITY, IA 522409070 Expiration Date: 01/12/2016 09/13/2012 592 Endorsements: 3 Mailing Address: 5038 AMERICAN LEGION RD Restrictions: Corrective Lenses M14 SE Date of Birth: 1/12/1969 Mailing City/State: IOWA CITY, IA 522409070 Sex: M History Information Convictions Customer #: 4289265 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Speed Citation Date Conviction Date ACD _ Explanation County JUR 06/23/2010 07/14/2010. 592 Speed Linn -.IA 09/16/2010 10/18/2010 _S92 Speed '.Linn IA 08/13/2012 _ 09/13/2012 592 Speed - Johnson IA 12/10/2012 _ 01/11/2013 M14 Fail to Obey Traffic Sign/Signal Johnson _ '.IA 04/01/2013 04/11/2013 F04 Seat Belt Violation Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number 3UR 07/15/2012 .._ _ _.. r695214 _.... _... IA 10/11/2014 _.. 1821287 _.IA 11/07/2014 :825843 _.... _ IA. Name: Bane, Thomas Daniel DL/ID: 251CCO152 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 custodian 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: g✓••...••;!/��pi 5/20/2015 IOWA'?',.f D. 0. T. ®%'"•^'$t�_=� °.BAN%` Office of Driver Services Iowa Department of Transportation Name: Bane, Thomas Daniel DL/ID: 251CCO152 FMay.15. 20151, 19 FM Div of Gr veinal Investigation 06/13/201a gP0'1l l/moo N. 1/h roos -♦, STATE OF IOWA Criminal History Record Check Request Form To: intra Division of Ci-Bninal lnvet igation ,Support Opersfions Bureau, 1" Flnor 215 F. 7"' Street Des Moines, Iowa 50119 (515) 725.6066 (515)775-6090 Fay I mill requesfilm an Iowa Criminal I-Iistory Record Chenk nn - DCI Account Ivtumber: C7 O (iropplicable) Funin-_ Ct4y of iotva Clip City Clurlt's Office -- — — 410 E_ Washington Street Iowa City, IA 52240 Phone: 319-356-5041 rax: 319-3§6-5497— L,aet Name (mandatary) - First Name (inandalory) Middle Natne (recommended) � N r I A0 - �orlr el Date of RiMh tntandam,)9 Gender (ntandalen) _ Social NunlU(eer' (recommended) 12-16 Male ❑Fclnale �Seccuuri / o V o EJ < yU$ _ Waiver hiforrnnliow Without a signed waiver from tie subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter OIL For complete criminal history record information, as aflowed by law, always ohlain & waiver 51 nature: from the Subjtct of the request Waiver Rel enSe; I hereby give permission Por rhe above regnesling olTicial m conduct art lotsa criminal history record check with the Division or Criminal Ynvemligation(DCO, Any criminal hlstnrydala emmtming n¢ analis maintained by the DOknaa��y be releaseedd�as allowed by Iowa Criminal History Record Check Results r>c, msc nilly) As of 5/ ` a search of the luo),ided name- and date of birth revealed: EJ < ' -1 No lova Criminal )distory Record fouled with DCI vi ,rn ; .q .. — L n G Lidl` Iowa C;ri,ninal History Record attached, I7CI ;,+ Zr r 1101.77 (08/25110) Received Time May, 13. 2015 4 42PM Nlo.7868 'May, 15. 2015 1:40PM Div of Crlminal Investigation No. 7377 P. 2/5 IOWA CRIMINAL HISTORY DCI 00370225 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 4 DATE PRINTED - 2015/05/15 DCI :00370225 NAME: BANE,THOMAS DANIEL BANE,TOM DOB SEX RAC HGT WGT EYE HAIR SKN POB 19690112 M W 511 175 BRO SLK FAR IA ADDITIONAL IDENTIFIERS CCH RECORD •�W 01 ARRESTED 19871227 AGENCY: IA0520200 IOWA CITY PO CHARGE NO- 01 IA STATUTE IA123-46 PUBLIC INTO% TRK#: L33479301 CHARGE NO- 02 IA STATUTE IA719-1 INTERFERENCE WITH OFFICIAL ACTS TRK#: L33479302 CHARGE NO- 03 IA STATUTE IA723-4-1 DISORDERLY CONDUCT TRK#: L33479303 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA123.46 CONSUMPTION / INTOXICATION - 1976 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479301 SENTENCE DISP EFF DAT PLEAD GUILTY 19871227 FINE $25 19871.227 COURT COSTS $20 19871227 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA719.1(1)A INTERFERENCE W/OFFICIAL ACTS CHARGE CLASS: MISDEMEANOR CONVICTION TRK#t L33479302 SENTENCE DISP EFF DAT PLEAD GUILTY 19871227 FINE $10 19871227 COURT COSTS $20 19871227 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE: IA723.4(i) DISORDERLY CONDUCT - PIOHTING OR VIOLENT BEHAVIOR CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479303 SENTENCE DISP EFF DAT PLEAD GUILTY 19871227 FINE $10 19871227 No. 7377 P. 2/5 Ni a y. 15. 2015 1'.40PM Div of Criminal Investigation COURT COSTS $20 02 ARRESTED 19890507 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA123-46 PUBLIC INTO% TRK#: 1,33479401 CHARGE NO- 02 TA STATUTE TA714-2-5 THEFT 5TH DEGREE TRH#: L33479402 CHARGE NO- 03 IA STATUTE IA719-1 INTERFERENCE WITH OFFICIAL ACTS TRK#: L33479403 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA123.46 CONSUMPTION / INTOXICATION - 1978 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479401 SENTENCE PLEAD GUILTY FINE $25 COURT COSTS $20 COURT DISPOSITION AGENCY: TA052015J JOHNSON CO DIST COURT COUNT NO- 02 TA STATUTE: IA714.2(5) THEFT STH DEGREE - 197E CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479402 SENTENCE PLEAD GUILTY FINE $75 COURT COSTS $20 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE: IA719.1(1)A INTERFERENCE W/OFFICIAL ACTS CHARGE CLASS: MISDEMEANOR CONVICTION TRK##! L33479403 SENTENCE PLEAD GUILTY FINE $15 COURT COSTS $20 03 ARRESTED 19910607 AGENCY: TA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 DCI 00370225 PAGE 2 OF 4 19871227 DISP RFP DAT 19890508 19890508 19890508 DISP EFF DAT 19890627 19890627 19890627 No./311 NaO 5. 2015 1:40PN Div of Criminal Invesfi;ation Owl TRK#+ L33479501 CHARGE NO- 02 IA STATUTE IA204-401-3 POSSESS SCHEDVGE I/MARIJUANA TRK#: L33479502 COURT DISPOSITION AGENCY: IAO$2015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: XA204.401(3)(B', POSSESSION OF MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479501 SENTENCE JAIL 1D CREDIT W/TIME SERVED 7H COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA321J-2 owl CHARGE CLASS: NON CONVICTION TRK#: L33479502 SENTENCE DEFERRED JUDGEMENT DISCHARGED FROM DEFERRED JUDGEMENT 04 ARRESTED 19950226 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- O1 IA STATUTE IA124-401 P0069SSION-SCH I TRK#: 014619101 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-204-4-M POSSESS MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRW 014619101 SUBSTANCE ABUSE EVALUATION SENTENCE SUSPENDED JAIL 30D FINE $250 COURT COSTS $75 PROBATION lY COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 1A STATUTE: IA665-4(2) CONTEMPT OF COURT CNARGE CLASS: MISDEMEANOR CONVICTION DCI 00370225 PAGE 3 OF 4 DISE EFF DAT 19910626 19910626 DISP EFF DAT 19910926 19920520 DISP EFF DAT 19950330 19950330 19950330 19950330 No./311 P, 4/h Mi y.15 2015 1'40FM Div of Criminal Inv.stigation Na 1311 F, 5%5 DCI 00370225 PAGE 4 OF 4 TRK#: 014619102 SENTENCE DISP EFF DAT SAIL 5D 19980915 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION r"