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Home My WebLink About16-0071 � 1 wWl®� txi �lrlli�_ CITY OF IOWA CITY 410 Fast Washington Slrcet Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO. / (42—(_ �i7 77 (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 1. Name (REQUIRED) Th P 2. Address (REQUIRED) U? 3. Contact Information (REQUIRED) Email: (All wri 4a. Chauffeur's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) �fL/7 5. Prior experie ce in trans ortatio9 o_f passe A •• � Cell Phone: _ 30 n communication se via email) r / - I' -zI M C. 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? rec T eofy�offe se) Where When f2 2-7 _ 7 What happened to the charge? (Circle one) r Q Convicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrestei3/ cTiarged with any traffic offenses in the last five years? e f Type of offense Where When d - +� sd G � o What happened to the charge? (Circle one) Convicted 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? ka Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please prom !" DEPARTMENT OF CRIMINAL INVESTIGATIONr (DCI) REPORT AND STATE §FHRTiFILD' y..�. DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF$EV15W I You must apply for an individual Department of Criminal Investigation Report (form availabii' tlporPreques (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) T 0212015 W�q� tv& t-tl w4� Al&r e nal Y- � f 4TCI k 1 A `'— fi� P �5or 60dh c� nc7,4 5 ' de r jlcr 'r��{yca�i l G� �IJ AO'k 12 �27 oo-7 R CI J 12 - Z7 -el" -2 Tcwq Gil s-7-9? :'amk Cly/ Ga ;z./t/ltlC 2, -2vP-q5. APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certi th t I have issued to me by the Iowa Dep ment f Transportation valid Chauffeur's license number Z issued on xpiring on 74 I understand that if I falsely answer any ques ions in this in green, that this application may be denied. I atha 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 arc", U G Date /5 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by �no 5 Fj c `p on this day of -I_C�—a,-1 2-01 L-0 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 Ch a 's license �1 Z SIgnature of Police Chief o ft-4�` I\ 4 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. Signat a of City Clerk or designee Website update ci rDVJDRiveaoceaaarszmaam�ded.Doc 0342015 r_ pre Office Use Only = •. , Website update ci rDVJDRiveaoceaaarszmaam�ded.Doc 0342015 r_ Office Use Only = •. , Approved application DCI report - State certified driving record' Website update ci rDVJDRiveaoceaaarszmaam�ded.Doc 0342015 i c y V-TTrci •v cdy G� aef .�rWu �Y j2ez�-�7 i 5 ord'ol/?� c Oh VV ra w5,l &5'c � N J iC IU%N A'DOT ww.1., iiAITTE4. t S`ir,'t l' 14 1 (US T'uEartsEtlVIP�-- Inquiry 1/6/2016 Date: Customer 4289265 P: Name: Bane, Thomas Daniel Pagel of 2 Office of Driver Services. PO Box 3204 i Iles Moines, LA 5033679204 Phone: 515-244-9124 1800-532-1121 I fax-. 515-.239-1.837 www:iowadrAgov Certified Abstract of Driving Record DL/ID 9: 251CCO152 (IA) CDL Permit Class: None Class: D Audit if: 9689750 Address: 5038 AMERICAN LEGION Issue Date: 01/06/2016 RD SE Expiration 01/12/2021 Date: City/State: IOWA CITY, IA Endorsements: 3 CDL Permit Issue None Date: CDL Permit None Expiration Date: Explanation CDL Permit None Endorsements: Restrictions: Corrective Lenses CDL Permit None Restrictions: RD SE ID Status: None History Information Convictions Citation Dare 522409070 i'co Explanation county Mailing 5038 AMERICAN LEGION Restrictions: Corrective Lenses DL Status: VAL Address: RD SE Restriction None CDL Status: None Mailing IOWA CITY, IA Supplement: CDL Permit ELG City/State: 522409070 :Johnson Status: Date of 1/12/1969 CDL Cert Status: None Birth: Sex: M CDL Med Status: None History Information Convictions Citation Dare Conviction Date i'co Explanation county IUR 08/13/2012 ._ . -. 09/13/2012 .. .S92 _ ..-.... Speed .....___.........._....c Johnson IA 12/10/2012 01/11/2013 M14 S' -I... _.. 'Fail to Ohey Traffic Slgn/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 IUR 07/15/2012 -'.695214 '.IA 10/11/2014'821287 _..._. -- _- _. --- IA 11/07/2014 ......825843..... ..... IA... w c3 Name: Bane, Thomas Daniel DL/ID: 251CCO152 :7 rn •. t- v, Pursuant to Iowa Code §321.10, I, Km Snook, Director of Office of Driver Services, Iowa DepaRtdt oi-Transppr�ation, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this I rtrue afld accuF_at copy of an official record currently in the custody of said office, and that I have been authorized by the Director•4fthe inyva Dep ant of Transportation to so certify. , _ - N 1 NH t In witness whereof, I have caused my signature and the seal of the Department to be set upon thi§ clDCLmenf at Ankeny, Iowa this date: - 1/6/2016 iUtLUnl4i ulv oT Lrim nal Invest .. Cl er.. --•�-- -'- ---- -. _ gdt I On 0110ei201e 17sN0. 482136 f'.., o2iaoz STATE OF IOWA. Criiiiiinal History Record Check i Request Forli9d To: town Division of crimina111tvestigation Supper( Operatloas Bureau, 0 Ftoor 21 s C. 9'e street DesMolues,lowa 50319 (515) 725.6066 (515) 725-60!30 Fax D � 0 I/1jiI DClAccountNumber: [.)cL!�E— (if applimble) From: CiP of to+vaCit City Clerk's Office 410 r. Washin ton street ioeva CIt.V ]a 52240 !hone; 319.356-5041 Fax: 319-356-5497 -- Male OFeinale It -00)§e rrriiver Infor"MUOru Wilhoul asigned waiver frore+ the subject of the request, a completecriminal history record may not be releasable, per Code of Iowa, Chapter 692,2. For comvlete cr(mMal history record iuforinailou, as allowed by law, ahvays ohtaln a waivers( nature from [he sub ect of the request. r3'aiver jib%@rySB: 1 hereby give pcnnissim7 for the above requesting affcial to conduce ou lou•a criminol history ruord check ,ciUr U7e Division of Climinal L+vesligalien (DCq. Any eeiminal history date canmming me Ihel is mvnlainad by the DCI may be released es allowed bylaw. Wefver Signature: Iowa CI imipal History Record ChecLc Results As of (` a (DCI use only) search Of the Provided cisme and date of birth revealed,` No lowa Criminal History Record found With DCI v> EL Iowa Criminalc History Record attached, llCI #� �'Z s - _ •, 4 DCI initinls_____� r•o -� r DCI-77 (08/2S/10)- - �c Received Time Jan, 6. 2016 4:24PM No,4931 oan. 0. ZV10 lu:IuAM , uiv 07 criminal Investigation IOWA CRIMINAL HISTORY DCI 00370225 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 4 DATE PRINTED- DCI:00370225 2016/01/08 NAME: BANE,THOMAS DANIEL BANE,TON DOB SEX RAC HOT WGT EYE HAIR SKN POB 19690112 M W 511 195 BRO BLK FAR IA ADDITIONAL IDENTIFIERS N CCH RECORD rw• 01 ARRESTED 19871227 AGENCY: IA0520200 IOWA CITY PD CHARGE 00- 01 IA STATUTE IA123-46 PUBLIC INTOX TRH#: L33479301 CHARGE NO- 02 IA STATUTE IA719-1 INTBRFERBNCE 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 19871227 COURT COSTS $20 19871227 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA719.1(1)A INTBRFERBNCE W/OFFICIAL ACTS CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479302 SENTENCE DISP EFT OAT PLEAD GUILTY _ 19871227 FINE $10 19871227 COURT COSTS $20 19671227 COURT DISPOSITION AGENCY: XA052015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE: IA723.4(1) DISORDERLY CONDUCT - FIGHTING OR VIOLENT BEHAVIOR CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479303 SENTENCE DISP EFF DAT PLEAD GUILTY 19871227 FINE $10 19671227 No, 4621 P. 2 N .. ,kx dart 0 to 10 1 vtzOAm VIv 0T 6r Aril na. Investigation DCI 00370225 PAGE 2 OF 4 COURT COSTS $20 19071227 02 ARRESTED 19890507 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA123-46 PUBLIC INTOX ti TRK#; L33479401 CHARGE NO- 02 IA STATUTE IA714-2-5 THEFT STH DEGREE TRK#: L33479402 CHARGE 140- 03 IA STATUTE IA719-1 INTERFERBRCE WITH OFFICIAL ACTS TRK#: L33479403 COURT DISPOSITION AGENCY: XA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA123.46 CONSUMPTION / INTOXICATION - 1978 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33475401 SENTENCE PLEAD GUILTY FINE $25 COURT COSTS $20 COURT D19POSITION AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA714.2(5) THEFT STH DEGREE - 1978 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/OFFICTAL ACTS CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1,33479403 SENTENCE PLEAD GUILTY FINE $15 COURT COSTS $20 03 ARRESTED 19910607 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 DISP EFF DAT 19890508 19890508 19890506 DISP EFF DAT 19890627 19890627 19890627 No, 4811 P, 3 ti •�,.„. -�-.. as P �i Jan. 6. ZU1b IO;Z6RM Div oT Criminai invesiigaiion DCI 00370225 PAGE 3 OF 4 OWI TRK#: L33479501 CHARGE NO— 02 SA STATUTE IA204-401-3 POSSESS SCHEDULE I/MARIJUANA TRK#: L33479502 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE; IA204.401(3)(B. POSSESSION OF MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479501 SENTENCE DISP EFF DAT JAIL 1D 19910526 CREDIT W/TIME SERVED 7H 19910826 COURT DISPOSITION AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO— 02 IA STATUTE: IA321J-2 OWI N CHARGE CLASS: NON CONVICTION TRK#: L33479502 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT -':Z= 19910926 DISCHARGED FROM 19920820 DEFERRED JUDGEMENT 04 ARRESTED 19950226 AGENCY; IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA124-401 POSSESSION—SCH I TRK#: 014619101 G— COURT DISPOSITION rn AGENCY: XA052015J JOHNSON CO DIST COURT COUNT 110- 01 IA STATUTE: IA124-204-4—M POSSESS MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 014619101 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EES DAT SUSPENDED JAIL 30D 19950330 FINE $250 19950330 COURT COSTS x$75 19950330 PROBATION 1Y 19950330 COURT DISPOSITION AGENCYc IA05201W JOHNSON CO DIST COURT COUNT NO— 02 IA STATUTE: IA665-4(2) CONTEMPT OF COURT CHARGE CLASS: MISDEMEANOR CONVICTION No. 4821 P. 4 N .lbw -':Z= i G— rn Jan. 8. 2016 10:26AM Div of Criminal Investigation TRK#: 014619102 SENTENCE JAIL 5D DCI 00370225 PAGE 4 OF 4 DISP EFF DAT /9980915 AN ARREST WITHOUT DISPOSITION I5 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 I No.4821 P. 5 p 4 i rT