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Home My WebLink About16-150� r 1 _ 4 t CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-SO40 (319) 356-5497 FAX IDENTIFICATION NO. l � —1!3- b (Office Use Only) APPLICATION FOR TAXICAB I 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. Name (REQUIRED) ;a«a 2. Address (REQUIRED) 3o I Middle Last 3. Contact Information (REQUIRED) Email: /(/%t/� �y/r��rz2�( S7&Rglr„4rC3CeilPhone: (All written communicate— on sent a email) 4a. Driver's License expiration date (REQUIRED) - b. Taxicab Business Name (REQUIRED) _ 'ltl E 5. Prior experience in transportation of passengers: 5. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? [16 5 Type of offense Where When What happened to the char e? (Circle one) C ted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested/ charged with any traffic offenses in the last five years? k� Type of offense What happened to the charge? (Circle one) Where When 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? h 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 name(s) 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) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number j 'CG SfO, d issued on '7 , 7//G expiring on I understand that if 1 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, ofthe City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by �—v� v s �r�,h� a L on this �� day of Public in And for the State of Iowa -7 12111 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). Q Expiration date of river's license Signature of Police tr6ief 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. Signbtufe of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update Date 01nk MDRIVB DGEA PL92014a.,nd tl DOC 07/2016 Ju1,26. 2016 4:12PM Div o' Criminal Investigation ND.9283 P. 1/5 Frmm:cary 01 lows cny dark �rrie6 a,aa 09/26/2016 16:.0 d6B0 r.uu2/002 r1`pe DfYIIPIq,Ve STATE I IOWA , 1 `� towaCriminal History Record t Request s Form �Nrs,.rol ru�� To: Iowa Division of Criminal lovtmigation Support Operations Bureau, I" Floor 215 L. I,h Strtet Des Moines, lowa 50319 (515) 725-6066 (515) 725-600 Fax I am reauestinc an Inwa Criminni laicro„- karnrA rhoA, DCI Account Number: y 94 z --,F (irapplicaAle) From: City orlowa City City Clerk's Office 610 E, 'Wa1111ul� on Street ry Towa City, TA 52240 Phone: 319-356.5041 Fax: 319-356-5497 last Name (111andolory) Mr8t Name hrandaiervi Iddle Name (recommended) —Lic L76 Date of Birth (mandalory) Gender (mandatory) Social Securi , Nuinher (recammonded) /,WE /70 MMftle ❑I+emale Waits' Jnf01'77t0fi07a: Without a signed waiver from the subject ofthe request, a complete criminal history record may no( be releasable, per Code oflown, Chapter 692,2. For complete erhnlnel history record information, as allowed bylaw, always obtain a waiver Signature from the sub'ect of the re ues [, l•1yt71 Ver Release: l hereby give permission for the above regnesiiug ofncial to conduct an )owe «iminal hlslory record check wish the Division of Crin incl Investigation (DCI). Ajiy criminal history Bala conaming me dial is maintained by the IM may b ased es also 'cd by law. Waiver Signature: MCI ase nnly) As of _ f /'p2 2!5—/l 69 a search of the provided name and date o£bi 1h revealed: ❑ No Iowa Criminal History Recoyd found with DCl -= F -0 Iowa Criminal 1-listory Record attached, llCl #`-t3a-0 55-- 0 U) LJ DCI initials Ci d DCI -77 (08125/10) Received Time Jul.25 2016 4:30PM klo.0244 Ju1.2S. 2016 4;12PM Div of Crimina' investigation No.9283 P. 2/5 DCX :00932D55 NAME r BRANDON,LUCAS JOHN BRANDON, MARSHMALLOW DOB SEX RAC 19900128 M W IOWA CRIMINAL HISTORY FELONY CONVICTION DCI 00832055 PAGE 1 OF 2 DATE PRINTED - 2016/07/28 HOT WGT EYE HAIR SKN POE 507 297 BLU BLN MED IA ADDITIONAL IDENTIP12RS PHOTO AVAILABLE; Y CCH RECORD ++• 01 ARRESTED 20000307 AGENCY: TA0790100 GRINNELL PD CHARGE NO- 01 IA STATUTE IA714.2(5) THEFT STH DEGREE - 1978 TRK#: 061312401 COURT DISPOSITION AGENCY: IA079015J POWESHIEK CO DIST COURT COUNT NO- 01 IA STATUTE: IA714.2(5) THEFT STH DEGREE - 1978 COURT CASE ID: 06791 SMEM013647 CHARGE CLASS; MISDEMEANOR CONVICTION TRK#: 081312401 SENTENCE DISP EPP DAT FINE $200 20000313 02 ARRESTED 20080908 AGENCY: IA0790100 GRINNELL PD CHARGE NO- 01 IA STATUTE IA124.4 W l)(d)-F CONTROLLED SUBSTANCE VIOL. TRK#: 080157101 COURT DISPOSITION AGENCY: IA079015J POWESHIEK CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(1)(D. CONTROLLED SUBSTANCE VIOL. COURT CASE ID: 08791 FECROO9921 CHARGE CLASS: FELONY CONVICTION TRK#: 060157101 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EPP DAT DEFERRED JUDOEMENT 20090316 PROBATION lY 20090316 PRISON 5Y 20100405 REVOKED 20100405 03 RECEIVED 20100406 AGENCY: IA052015M OAKDALE IMCC CHARGE NO- 01 IA STATUTE IA690.4 CUSTODY IOWA DEPT OF CORRECTIONS TRK#: CB008OV01 INMATE #: 6332259 CUSTODY AGENCY: IA077015G ADULT PAROLE SVC A 20101220 Ju 1, 28, 2036 4:12 PM Div of Criminal Investigation No. 9283 P. 3%5 DCI 00832055 PAGE 2 OF 2 PAROLED 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 NDN -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 Iowa Department of Transportation Office d Dwer Services (Tdl Ffea)8W-5n-1121 4" Pt) 9W 9204, Des 6kletea,1A503064204 515.2444124 FAX 5155-238.1837 Inquiry Date: Name: Address: City/State: 7/24/2016 Brandon, Lucas John 309 BROAD ST GRINNELL, IA 501122523 Mailing Address: 309 BROAD ST Mailing GRINNELL, IA City/State: 501122523 Certified Abstract of Driving Record DL/ID #: Class: Audit #: Issue Date: Expiration Date: Endorsements: Restrictions: Date of Birth: Sex: 232CC8042 (IA) C 9632148 12/10/2015 01/28/2018 NONE NONE 1/28/1990 M History Information CLEAR DRIVING RECORD Name: Brandon, Lucas John DL/ID: 232CC8042 Customer #: 4615517 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Pursuant to Iowa Code §321.10, I, Melissa Spiegel, 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: 7/24/2016 IOWA`: :o D. 0. T.. - r Office of Driver Services Iowa Department of Transporation Name: Brandon, Lucas John DL/ID: 232CC8042