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Home My WebLink About17-019� atlW®r�Il CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO (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 2. Address (REQUIRED) ;0 3. Contact Information (REQUIRED) Email: _t R" (All written ( 4a. Driver's License expiration date (REQUIRED) . k N Last 0 I \7-1 P T"e6-Cf'Cell Phone:.'?F/ el,30,? a )mmunication sent via email) -q 201% b. Taxicab Business Name (REQUIRED) V C I/ Cot, Ot,-6 5. Prior experience in transportation of passengers: 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Where 4 ie (4 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended lead G 'ty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where When 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? NO Type of offense Where When 0 9. Have you eve{ applied to be an Iowa City taxi driver using a different name? If yes, please pr da tlAtamt (s}- 1`J 0 _ 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 Gla s -"q sh ' m 0 7b - d"tz fayL APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hebxx certi at I have issued to me by the Iowa Department of Transportation a valid Driver's license number rg I � 8 M -6-� & to issued on / '�S- 7 expiring on 9—q-1 % . 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, CF apter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date �4 / STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by 2i f i am �u6cL on this 3l7 day of IT"[. „� r.. 7-1'"1 _ 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). date of nvers license 2/z/1� 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. SioiatAe of City Clerk or dbsignee Date _s T'''1 Cc Office Use Only '— w Approved applicationrn DCI report =x; Co State certified driving record c.a Website update N) aan✓rnXORNBADGEAPPre2014a"nd� ooc 07/2016 C410WA00T wwwJowado ov SMARTER I SIMPLER I CUSTOMER DRIVEN g Office of Driver Services PO Box 9204 I Des Moines, IA 5030"204 Phone: 515-244-91241800-532-11211 Pax: 515-239-1837 www.lowadot.gov Inquiry Date: Customer Name: Certified Abstract of Driving Record 1/5/2017 DL/ID #: 138555266 (IA) CDL Permit Class: None 4536133 Busa, Brian Milton Class: D Audit #: 1531601 Address: 102 W DOUGHERTY DR Issue Date: 01/05/2017 Expiration 01/31/2025 History Information CLEAR DRIVING RECORD Name: Busa, Brian Milton DL/ID: 138555266 CDL Permit Iq ..e Date: CDL Permit Expiration Date: CDL Permit Endorsements: CDL Permit Restrictions: ID Status: DL Status: CDL Status: CDL Permit Status: CDL Cert Status: CDL Med Status: None None None None VAL VAL None ELG None None Pursuant to Iowa Code 4321.10, 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: d01CLE Date: City/State: LONE TREE, IA Endorsements:3 T1 `•n 527557799 444' Mailing PO BOX 499 Restrictions: NONE Address: Office of Driver Services Restriction None Mailing LONE TREE, IA Supplement: City/State: 527550499 Date of 1/31/1977 Birth: CO Sex: M History Information CLEAR DRIVING RECORD Name: Busa, Brian Milton DL/ID: 138555266 CDL Permit Iq ..e Date: CDL Permit Expiration Date: CDL Permit Endorsements: CDL Permit Restrictions: ID Status: DL Status: CDL Status: CDL Permit Status: CDL Cert Status: CDL Med Status: None None None None VAL VAL None ELG None None Pursuant to Iowa Code 4321.10, 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: d01CLE r� ,�R .. • :�y, 10WA ' '' 1/s/zo l7 T1 `•n „y 444' ly p lli ®F Office of Driver Services BBIVEa Iowa Department of Transportation"" r -r1 �' r CO W Name: Busa, Brian Milton DL/ID: 138555266 r.� dan./g. LUI1 L: UgYNI Uiv of Urlminal I n v e s t i g a t i 0 n No. 2077 01/2ui 2U v Ib:Sbrel low Cab or Iowa ulty (FAX)3193362JUE STATE OF IOWA Criminal History Record Check Request h+orm \ To: Iowa Division of criminal 1nVes(Igsticn Support OParatlons Bureau, 161 Floor 215 B. 7" Street Des Molnet, Iowa 50319 (515) 725,6066 (535)128.6080 Nx ASO 'aNs4 1-31-1977 P. 4/B P,002/002 DCI Account Number; X9967rF (if eppllcebie) From; Yellow Cab of Yowa city AM Fx 428 Yowa Clty, IA. 52244 Phone] (319)338.9777 Fax: (319) 339-7302 Male ❑Female LVA101 sle 1 41310 (recommended) " ioglaL3eourlty TVuraber (meow WB°17�a-�� Waiver Information, Without a signed walver from the subject of the regpest, a complete orimibal history record may no be releasable, par Coda of Io)va, Chapter 692,2, For gomploto criminal historyraeord Information, at allowed by law, always obtain a walver denature tram We subtect of the request. Wati'er Release; I hereby glue aermlsrfon Aarthe above requellina omclol to mnducl On Iowa crlminei historyreeord Check with the Division ofCrlminel Invailptlen (DCO, Any criminal hb(ery due ooncemina me Ihu is malar ea by�.the DCJ J may be re)dued as ellowei( by IaW, Waiver Slrnafurdr ' .uv rrw V A AAA&AAA"A AJIALJ%,V t V L%UL;VILA %_AAV lea JMr.,JUjtta tDCt life eatyl As of a search of the provided name and data of birth revoaaod F..J ❑ No Iowa Criminal History Reoord found with DCT tA� Iowa Criminal History Record attached, DCI Z�I L DCI Initials,_ DCI -77 (06/25/10) Rrr>ivod Tinr .lao 9n 9017 d-ORPM Nn 106A ' . Jan,24. 2017 2:05PM Div of Criminal Investigation IOWA CRIMINAL HISTORY FELONY CONVICTION DCI:00424337 NAME: 130OZER BUSA,BOOZER BUSA,BRIAN MILTON DOB SEX RAC HGT WGT EYE 19770131 M W 510 150 BLU ADDITIONAL IDENTIFIERS TAT L ARM TAT L LEG TAT R ARM CCH RECORD *** DCT 00424337 PAGE 1 OF 4 DATE PRINTED - 2017/01/24 HAIR SKN POB BRO MED IA 01 RECEIVED 19910808 N a AGENCY: IA042015C ELDORA ITS FOR BOYS CHARGE NO- 01 IA STATUTE IA713-5 BURGLARY 2ND DEG W TRK#: L40206601 INMATE #: 24398 COURT DISPOSITION r AGENCY: y. COUNT NO- 01 IA STATUTE: IA713-5 BURGLARY 2ND DEG 177 CHARGE CLASS: STATUS UNKNOWN TRK#: L40286601 y.b SENTENCE ADJUDICATED n� DELINQUENT SENTENCE OF UNTIL ISY OF AGE INDETERMINATE TO MAJORITY LENGTH CUSTODY AGENCY: IA077025G FAMILY CHILD SVC BUR A 19911013 PAROLED PLACED CUSTODY AGENCY: IA042015C ELDORA ITS FOR BOYS B 19931028 RECEIVED RET'D FOR RECOMMITMENT CUSTODY AGENCY: IA077025G FAMILY CHILD SVC BUR C 19940527 PAROLED PLACED 02 ARRESTED 19951125 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: 022554801 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT DISP EFF DAT 19910808 19910008 No. 2077 P. 5/8 N a C� = n J fri ? ..4 W C? r C� y. i � s O � nk 177 coCA y.b c.a n� Jan.24. 2017 2:05PM Div of Criminal Investigation No.2077 P. 6/8 COUNT NO- 01 IA STATUTE: IA321J-2 OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 022554801 SENTENCE JAIL 21) FINE $500 03 ARRESTED 19960227 Q AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA714-1-3 THEFT BY CHECK 3RD DEGREE TRK#: 022590801 COURT DISPOSITION W AGENCY! IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA714-1(3) THEFT 3RD CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 022590601 C.O. RESTITUTION SENTENCE DEFERRED JUDGEMENT tj N PROBATION lY 061297-PROB RVKD-90D SUSP;IY PROB;$500 FINE REVOKED COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE: IA665.4(2) CONTEMPT DISTRICT COURT - 1970 COURT CASE ID: 06521 AGCR040122 CHARGE CLASS. MISDEMEANOR CONVICTION TRK#: 022590803 SENTENCE JAIL 10D 04 ARRESTED 19960706 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA714-6 THEFT 2ND TRK#: 024191901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 TA STATUTE: IA714-2(2) THEFT 2ND COURT CASE ID: 06521 PECR041766 PCI 00424337 PAGE 2 OF 4 DISP EFF DAT 19960807 19960807 DISP EFF DAT 19960607 19960607 19970612 Q W rn C7'O C.O. ` tj N pan. A lUl/ 2:05PM Div of Criminal Investigation No, 2077 P. 7/8 DCI 00424337 PAGE 3 OF 4 CHARGE CLASS; FELONY CONVICTION TRK#: 024191901 RESTITUTION SENTENCE DISP EFP DAT COURT COSTS PROBATION AMENDED-lY 0 HOPE 19961213 HOUSE PROBATION 2Y 19961213 SUSPENDED 5Y 19961213 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA908-11 PROD VIOL -THEFT 2ND COURT CASE ID; 06521 FECR042766 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 024191902 SENTENCE DISP EFF DAT COURT COSTS PROD EXTENDED FOR 2YRS 19981022 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE: IA665.4(2) CONTEMPT DISTRICT COURT - 1978 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 024191903 SENTENCE DISP EFF DAT JAIL 30D 20000808 CREDIT W/TIME SERVED 20000808 05 ARRESTED 19980830 AGENCY. IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA714-2(4) THEFT 4TH DEG TRK#: 037246101 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA714-2-4 THEFT 4TH DEGREE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 037246101 RESTITUTION SENTENCE DISP EPP DAT FINE $250 19981231 06 ARRESTED 20000705 AGENCY: XA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: 040297901 -Jan, 24. 2017 2:05PM Div of Criminal Investigation DCI 00424337 PAGE 4 OF 4 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTR: IA321J-2 OWI 2ND OFFENSE COURT CASE ID; 06521 OWCRO56024 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 040297901 SENTENCE DISP EFF DAT JAIL 9D 20010105 FINE $1500 20010105 PRORATION lY 20010105 SUSPENDED 81D 20010105 CREDIT 9D, EVALUATION, DRUNK DRIVING SCHOOL REVOKED PROBATION REVOKED 20020625 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA665.4(2) CONTEMPT DISTRICT COURT - 1978 COURT CASE ID: 06521 OWCROS6024 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#; 040297902 SENTENCE JAIL 20D COURT DISPOSITION AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO- 04 IA STATUTE: IA665.4(2) No. 2077 P. 8/8 - CONTEMPT DISTRICT COURT - 1978 COURT CASE ID: 06521 OWCRO56024 CHARGE CLASS; MISDEMEANOR CONVICTION TRH#: 040297904 SENTENCE DISP EFF DAT JAIL 10D 20040213 a AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD art'1 MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF � w IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON-LAW�~� .. ENFORCEMENT AGENCIES BY THE DCT, ''. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IbENTIFICATION THIS RECORD I$ BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD -"a .lG �•-- COVERS THE SUBJECT OF YOUR INQUIRY. CO '. C,1 DIVISION OF CRIMINAL INVESTIGATION