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Home My WebLink About17-047.tlwoai�il CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED =� C, IDENTIFICATION NO. -7 — e2 !1_ )-'A y ri^ (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:cc<S-lf % c akl Cell Phone: C-3 1'913V -irk) Z (All written communicate n sent via email) 4a. Driver's License expiration date (REQUIRED) 3 --I Z4 I ZO 2,0 b. Taxicab Business Name (REQUIRED) _ 7 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? Type of offense Where 'en rn 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? 2!�ji 4i.-5 Type of offense Where W hen 1r> se.4 (,e. )H - What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 11 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 bean 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 T ' APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereb that I have issued to me by the Iowa Department of Transportation valid Driver's license number 1 �Ua Z - .". S' 3 issued on l �1_ expiring on `1[ZL[ �Z� 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) t' I �� Signature of Applicant \� jif, e,^ ` `4n_ Date Z/& tzm STATE OF IOWA ) COUNTY OF JOHNSON ) �� S b cribed and sworn to efore me b y Arm �5�, L _ (�). Sou on this of i- 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 r 1w Z0Zc> 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. StgRa&re of City Clerk or designee Date Office Use Only Approved application DCI report State certified driving record c.. $ --- Website update Geek/TAxIDRNBADGEAPPL92014amended.DOC 07/2016 4-010WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN WWW'IC)WadOt gOV Office of Driver Services PO Box 92041 Des Moines. IN 50306-9204 Phone: 515-244-9124 1800-532-11211 Fax: 515-239-1837 www.bwadot.gov Certified Abstract of Driving Record Inquiry Date: 2/3/2017 DL/ID #: 462LL4953 (IA) CDL Permit Class: None Customer #: 3267837 Class: D CDL Permit Issue None Date: Name: Wilson, Brandy Lynette Audit #: 1078131 CDL Permit None Expiration Date: Address: 332 ELLIS AVE APT 28 Issue Date: 06/14/2016 CDL Permit None Endorsements: Expiration Date: 09/24/2020 CDL Permit None Restrictions: City/State: IOWA CITY, IA 52240 Endorsements: 3 ID Status: None Mailing 308 E BURLINGTON ST BOX Restrictions: NONE DL Status: VAL Address: 143 Restriction None CDL Status: None Mailing IOWA CITY, IA 522404528 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 9/24/1976 CDL Cert Status: None Sex: F CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Wilson, Brandy Lynette DL/ID: 482LL4953 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: ......... .;iprrr 2/3/2017 IOWA. *�U1 f '••••'•� Office of Driver Services Iowa Department of Transportation Name: Wilson, Brandy Lynette DL/ID: 482LL4953 Febyva. 9; 2017 2:21 PM Div of Criminal investigation No ■ F,y m�m.11y o/ IOW. CITY CI.rk O,rl.. 319 3566697 02/06/2017 13:66 ■ Ll2rh'� F,-aeliky _/-)r/rrr:,r�C. 1.017—oa-6q � J STATE OF IOWA Criminal history Record Check oil Request Form 3387 P. 1100 >610 P.002/002 DC1 Account Number: �fa� - F ~�(if aOPliwbIt) -- To: lowe Division of Criminal Investigation From: City of Iowa City _ Support Operattous Bureau, P Floor City Clerk's Office 215 B. 7tn Street 410 B. Washington Street Des Moines, Iowa $0319 066 iewx a t>' (514)925-6050 Few Phone: 319-356-5041 Fax: 319-356.5497 1 am reauestina an Iawa Criminal Historo Record Check on )vast Name (inaadawy) First Name (mandatory) Middle Name (rn:ommended) Bate of Birth (mandatory) GendeY (mandatory) Social Security Number (reeon)meadd 9 f -'z'( l Ici -1 V ❑Male Female Ll g) - to - Liq Z 1 Waiver ruformation. Without a signed wailer frown the subject of the request, it complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. Fmcomplete criminal history record information, as allowed by law, always obtain a waiver signature frown the subject of the request. Waiver Release; i hereby give pclmission for plc aboveraquesting official to conduct m Iowa criminal history record Meek wid, the Division oftcrimili l Investigation (DCI). My uiminal history data concerning me that is maintained by the DCI may be released at allowed by law. WaiverSigncffure: a "'W 1' ZAG•(k, 17 Iowa Criminal History Record Check Results As of �� CL it f a search of the orovided name and date of birth revealed: ❑ No Iowa Criminal History Record found with DCI Iowa Criminal History Record attached, DC1 # n.3 IM - DO initials_ r 1)CI-77 (06/25/10) Roroiuea Timo Fob R 1017 19 -IUM ton 9006 v (Del use 01111,) D. Y. [u 11 [:[Irivi V I V 01 1,nminai :nVe.5:i9ariun rvu.»or is,Ir,eu ,. ra L IOWA CRIMINAL HISTORY DCI 00593188 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2017/02/09 DCI:00593188 NAME: WTLSON,BRANDY LYNETTE DOE SEX RAC HGT WGT EYE HAIR SKN POB 19740924 F W 507 145 BRO BRO FAR IA 19760924 ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y SC ABDOM SC ARM CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 19990303 AGENCY: IA02SOOOD DALLAS CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWI IST OFFENSE TRK#: 040710601 COURT DISPOSITION AGENCY: IAD25015J DALLAS CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2 OPER VSH WH INT OWI COURT CASE ID: OWCRO22960 CHARGE CLASSI MISDEMEANOR CONVICTION TRK#: 040710601 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EPF DAT JAIL 2D 19990708 FINE $1000 19990708 02 ARRESTED/TAKEN INTO CUSTODY 20021218 \ AGENCY: IA0250100 PERRY PD IA123.46 CHARGE NO- 01 IA STATUTE \� PUBLIC INTOX TRK#: 061696601 COURT DISPOSITION AGENCY: IA02SOISJ 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 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 INOUXRY. Feb. 9. 2017 2 : 2 1 P M Div of Criminal Investigation DIVISION OF CRIMINAL ZNVBSTIGATION CC..,/ No. 33DI .,iry