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Home My WebLink About17-023CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1 82 6 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. f -7 — 07-3 (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 3. Contact Information (REQUIRED) Email: e:�S Cf 12!1et Co— Cell Phone: (All written communicate n sent via email) 4a. Driver's License expiration date (REQUIRED) ) �7 Z�l ZO 17 b. Taxicab Business Name (REQUIRED) Vtlla-J 5. Prior experience in transportation of passengers: "3 `jevS r.o 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where j Wen e Xe f�1t.;,T.ceP t.f+�+^.� In,cl.ru eir.^h a What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other,- Have you been arrested / charged with any traffic offenses in the last five years? 2cr.r� k c& rr S Type of offense Where When What happened to the charge? (Circle one) ff 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? 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 that I have issued to me by the Iowa Department of Transportation Q valid Driver's license number U q -Z 1 S 3 issued on t o,14, expiring on `11zq I Zb 20 . 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 ;~� .�d� - Date Z/L % zen : STATE OF IOWA ) COUNTY OF JOHNSON ) �� ybicribed and sworn _to _�efore me by on this 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 Driver's license Q 11W a Signature of Police Chief or designee l 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. (StgRatlire of City Clerk or designee Date +#*!++#*+##1!!YlTf!*T!T***###1T11ff!****»+########f!!f!!Tf!!**#+#+####!lTflTT1T++++#++####!#!Tf!!TT*#####Y11f1l1f11f!!f!!*f*##1#11!!#1#f!!!!T!! Office Use Only , J Approved application DCl report _ State certified driving record Website update -CrJ r -i - a • ca perk✓rAXIDRNBADGE L92014 mended.DOC 07/2016 `t ,10WA DOT T R I SIMPLER I CUSTOMER DRIVEN vvww.lOWadOt gOV SMARTER Offfce of Driver Services PO Box 9204 1 Des Moines, A 50306-9204 Phone: 515-2449124 1 BOD -532-1121 I Fax: 515-239-1837 www:rowadat.gov Inquiry Date: 2/3/2017 Customer #: 3267837 Name: Wilson, Brandy Lynette Address: 332 ELLIS AVE APT 28 City/State: IOWA CITY, IA 52240 Mailing 308 E BURLINGTON ST BOX Address: 143 Mailing IOWA CITY, IA 522404528 City/State: Date of Birth: 9/24/1976 Sex: F Certified Abstract of Driving Record DL/ID #: 482LL4953 (IA) Class: D Audit #: 1078131 Issue Date: 06/14/2016 Expiration Date: 09/24/2020 Endorsements: 3 Restrictions: NONE Restriction None Supplement: History Information CLEAR DRIVING RECORD Name: Wilson, Brandy Lynette DL/ID: 482LL4953 CDL Permit Class: CDL Permit Issue 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 None None VAL None ELG None None 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: ......... .,.`�� 2/3/2017 IOWA s ,'4 D. 0. T. _ *I �a�oe4Nre-e %f 0e1 r Office of Driver Services Iowa Department of Transportation Name: Wilson, Brandy Lynette DL/ID: 482LL4953 F•ebrzb,. 2017 2:21 PM Div of Criminal Investigation No r Rrn m•� Ily or I.W. allyrblora /(Ito 319 13GBGa99 02/OB/207i 13:66 • 1,1ee z F�aeli _A/(nas.r�C. 2Dr7—oa CXj b STATE OF IOWA /. Criminal history Record Check 1 Request Form 3387 P. IY,Pke aolo P.002/002 DCI Account Number: Van'; , _ F (if applieablc) To: Iowa Division of Criminal Investigation From: City of town City Support Operations Bureau, 1'I Floor Cify Clerk's Office 215 M 7th Street 410 E. Washington Street Des Moines, Iowa 50319 066 iovra�i� ttri�3d (515) 72S-6000 Fax Phone: 319-356-5041 Fax: 319-356.5497 Lam renuestine an Iowa Criminal History Record Check on: Bust Name (maadatonl First Name,(m?ndalory) middle Name (m ommcndeo L �.L Date of Birth (mandslory) ('sender (mandatory) Social Security ]lumber (recommended Waiver rnformatimt; Wid,out a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code oftova, Chapter 692.2. For complete criminal history record information, as allowed by law, always obtain a waiver signature from the subject of the request. Waiver R01eaSe: I hereby give permission for dm about «questing official to eoadact m lova criminal historyrecord clack o•id, the Divis[an of Criminal htrestigation(DO). Any crimioal histeyy data comeming me that is mainubied by the DCl may be relcesed as allowed bylaw. +b% Z1�lk,17 L6 WaiverSignrdare; nrL' � 1 . h-4-LC./M1' v Iom'a Criminal History Record Check Results (uCl ma wily) As of CL di r a search of the orovided name and date of birth revealed: ❑ No Iowa Criminal History Record found with DCI N, Iowa Criminal History Record attached, DC1 # DCI initials 1)C1-77 (08/25/10) POPaluarl Timc Fah 6 1617 11-16PM G 100G F•eb. 9. 2011 2:21PM Div of Criminal Investigation No.3381 _t IOWA CRIMINAL HISTORY DCI 00593188 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2017/02/09 DCI:00593188 NAME: WILSON,BRANDY LYNETTE DOB SEX RAC HGT WGT EYE HAIR SKN BOB 19740924 F W 507 145 ERO BRO FAR IA 19760924 ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y SC ABDOM SC ARM CCH RECORD +*w 01 ARRESTED/TAKEN INTO CUSTODY 19990303 AGENCY: IA0250000 DALLAS CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWI IST OFFENSE TRK#: 040710601 COURT DISPOSITION AGENCY: IA025DISJ DALLAS CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2 OPER VEH WH INT OWI COURT CASE ID: OWCRO22960 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 040710601 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT JAIL 2D 19990708 FINE $1000 19990706 02 ARRESTED/TAKEN INTO CUSTODY 20021218 AGENCY: IA0250100 PERRY PDQ CHARGE NO- 01 IA STATUTE IA123.46 PUBLIC INTOX �\ TRK#: 061696601 COURT DISPOSITION AGENCY: IA025015J DALLAS CO DIST COURT COUNT NO- 01 IA STATUTE: IA123.46 CONSUMPTION / INTOXICATION COURT CASE ID: 05251 SMAC045665 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 061696601 SENTENCE DISP EFF DAT FINE $100 20030113 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 ABSRNCE 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. • • •Feb. 9. 2017 2:21PM Div of Criminal Investigation DIVISION OF CRIMINAL INVESTIGATION CC,,/ No. 3387 ', %wv