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Home My WebLink About15-1491 r i :XIII � CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ 2 Address (REQUIRED) IDENTIFICATION NO.�— (Office Use Only) Rrw e.a E '� w ^yn5 APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police DepartMgn��revP!qy nF40 r3iade between 8 a.m. to 3 p.m., Monday — Friday) IBI Q: YIU 1-1 3. Contact Information (REQUIRED) Email: 0 22 ! aKZZ K:C4i k c, t Cwt (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) ' Cr "C b. Taxicab Business Name (REQUIRED) _ y c� 5. Prior experience in transportation of passengers: 5�3Z� I`'-` ("o— 12-7 13. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere9 of offense Where ,--jut CACS ',�' (6 A A j � V 1o,, -r,( 1 - When 2 n(�) What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended f lead G� Other 7. Have you been arrested / charged with any traffic offenses in the last five yearns... — Type of offense V,.lU Mek0 0\o«( 5: What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other �s 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? I U 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 names) �, ) U DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW You must apply for an individual Department of Criminal investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that 1 have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number issued on "3 (2- IS expiring on 3 6, l i- . 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 applicalgand I further agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisigps'of rte 5, Chapter,2, of ity Code. (Needs to be signed in front of a Notary Public) / ,, _._:.. Y_j Zai Signature of ApplicantL .- __ Date G- ***********hh*h##*ii*:F*%'********************_**_####**h##*hh##**kh**##*#**#**%R%ikR**.k%****k******##***************h*#hh#*t****k##*hY%R*'*k*u*'k** STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me byCcttr.tia,&(s�®foi�jv� on this Qq day of 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 3f h ' _b Signature of Polic 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 desig�nnta Office Use Only Approved application DCI report State certified driving record Website update �A '? P //5 Kate ClerkrFMIDRN6ADGEAPPL92014amended. ooc 0312015 N 6 CEJ � Ca ClerkrFMIDRN6ADGEAPPL92014amended. ooc 0312015 0 Ju i. 17. 201§ 10:19AM 07/16/2615 13:17 FAX Div of Criminal Investi;ation No.3301 P. I/2 + DU IOWA LE OU.) STATE OF IOWA 1'y'w Criminal history Record Check Request Form 'o Tol ]ow► Division of Crimloal lavestleetion Support Operations Bureau, 1" Floor 213 L 7° Street Des molnet, lows 50319 (515) 725-6066 (515) 725-6080 FAY ribs lruftltllVc* DCI Account Number: i Jo FG �^ ' From_ ft\avtfe ' 14X: 11 [o 5kewtAe QY Peonet 00 339 - Fill] 319 5S1' N uvaln w„uwu Last Name("Awia wy) •• �•• ••. FIBt Nama jn=&w2i Middle Name, „oommlIe "n Date of Birth (w -A - Gender mnaw Social$CCUU Number (1 mmerldm 3 "" � — � sle ❑Female 1 v l " � I � � r Waiver lry/brmaglan.' without a blued weber from the sublets or lee requcet, a cowplete criminal history record WAY not be releasable, per Code of low@, Cbapter69i2. For comalete crtminel hbtery record laronnation, ■e rllowod bylaw, always ola■in a Walveralmature from the Qblk2t of the rvquwt, Waiver Releare:I Wmby sive pv i alon to( ft•bnrc I 'nL olrwigl tc cendx, w lows edm4W hbmw r rd dwck with ernlVlrion ofCrimlml Invwnrpdon(DC1). Any cdminD binary d.mcamx d mslnulned by dr nCl lmy be Neeeed.r dlowea by law, WolperSfgnafar As of —`�5 . it search of the provided name and date of birth reveaird: ❑ No lows Criminal History Record found with DCI Iowa Criminal History Record attached, DCI ll DCI initials—L . DCI - 0.,.,I,,.A T mo A.,) 1F. IAIF I•IIPM Mn J)on (M uw onty) u.• rn Iv w 7lJ 1 � 1 Iv w Jul.11. 2015 10�29AM Vv of Criminal Investigation No 3301 P. 2/2 IOWA CRIMINAL RISTORY DCS 00902438 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- DCI:00882738 2015/07/17 NAME; BROWN,NATHAN RANDALL DOB SEX RAC HGT WGT EYE HAIR SRN POB 19000306 M W 603 260 BLU - BRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y SC R KNEE TAT CHEST TAT L ARM TAT R ARM TAT UL ARM CCH RECORD ... 01 ARRESTED 20091115 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- Ol IA STATUTE IA700.2A(2)(B) DOMESTIC ABUSE A83AULT WITHOUT INTENT CAUSING INJURY TRK#: IA0006101 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA723.4(1} DISORDERLY CONDUCT - FIGHTING OR VIOLENT BEHAVIOR COURT CASE ID: 06521 SRORD89015 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A0086101 RESTITUTION SENTENCE DISP EFF DAT FINE $100 20100409 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 ` 0410WADOT SN'ARiEB I <;11101-F I tliSTJWEF C}RItiE'{ vvvnvl Office of Driver Services PO Box 9204 g Des Moines, 1A 50306-5204 Phone -515-244-9124{800-532-1 1121 1fax: 5'15-:39-1837 w"Jo'aadrrt gov Inquiry Date: 7/29/2015 Name: Brown, Nathan Randall Address: 3175 HIGHWAY 22 LOT 22 City/State: RIVERSIDE, IA 523279601 Mailing Address: 3175 HIGHWAY 22 LOT 22 Mailing City/State: RIVERSIDE, IA 523279601 Convictions Certified Abstract of Driving Record DL/ID #: 239CC5786 (IA) Customer #: 2159919 Class: B ID Status: None Audit #: 8917424 DL Status: VAL Issue Date: 03/12/2015 CDL Status: VAL Expiration Date: 03/06/2016 CDL Cert Status: Excepted Interstate Endorsements: NONE CDL Med Status: None Restrictions: NONE Restriction None Date of Birth: 3/6/1980 Supplement: Sex: M History Information Citation Date Conviction Date ACD Explanation County JUR 09/11/2014 101/08/2015 M14 Fail to Obey Traffic Sign/Signal Ilohnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 10/04/2013 760447 IA - - -- Name: Brawn, Nathan Randall DL/ID: 239CC5786 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 lewd 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: ;�'••••'•VZ ?I'4 7/29/2015 •IOWA ®W D. 0. T. d1. �`'BBNEB Office of Driver Services Iowa Department of Transportation Name: Brown, Nathan Randall DL/ID: 239CC5786