The URL can be used to link to this page

Home My WebLink About17-117 IDENTIFICATION NO. 17-- J i7 I r I (Office Us Only) �/ bt +VIII .71/1470.ga i 14111.1 APPLICATION FOR TAXICAB I MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m.to 3 p.m., Monday-Friday) 410 East Washington Street Iowa City, Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX First MiddleLast 1. Name (REQUIRED) 0ck-k\ AV1 R I) 6h,w/N 2. Address (REQUIRED) 3 175 PI W Y 22 L 6 1 2Z 0:0Ms.AZ,i 4 52 3.27 3. Contact Information (REQUIRED) Email: r�c i{bco w"36$ ,:3 t-0-0, (0'Veil Phone: 19'y 00 �n I g 7 (All written commu ication sent via email) 4a. Driver's License expiration date (REQUIRED) 3/6 7.- b.Taxicab Business Name(REQUIRED) 114C4 r( (Y3 5. Prior experience in transportation of passengers: I"94-C(95 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? rQ 5 T of offen a Where , When tS�r 4 (L) � d3w0\CiI- IS- C" What happened to the charge?(Circle one) Convicted Dismissed Deferred Suspende Plead Guilty Other 7. Have you been arrested/charged with any traffic offenses in the last five years? NFD Type of offense Where When r-,. j E-d0Vey s. c)v\ul cut\-Si-. 1- 2,- Icam What happened to the charge?(Circle one) Convicted Dismissed Deferred Suspende Plead Guilt Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the Iasi five years? f� Type of offense Where Wha ` 1110 a. 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, plea -!n idg�the n ms) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND SATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIE?2EVIEW You must apply for an individual Department of Criminal Investigation Report(form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 4 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation valid Driver's license number 1215 C S 7`3 (o issued on 3-1 S-I b expiring on 3`1Q 2 I . 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 applicati. , and I further agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the pro: • : e.5 Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applica - Date STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by >V oekt,k_ on this —Z—et day of 1k �9 u Sid ��Z,• �� S J V.4 � $ Notary Public• and for file State of wa .io�we �l Expires e..7aeaad I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no infor"•- 'on which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of th- 'ity of I,wa City(Title 5, Chapter 2, City Code). .7172 f Expir- ion d- e of !river's license I fr / f ;1.r desi aeSignature f Poli ' nee g 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. ;)q :Ca ILS.' _ ign:ture of City Clerk J designee . Date ************************************************************************************************************************************************ Office Use Only C=/' Approved application ,., DCI report (1-‹ State certified driving record —� tQ r" Website update -� aerkITAXIDRIVBADGEAPPL92014amended.DOC 07/2016 IOWA uT SMARTER I SIMPLER I CUSTOMER DRIVEN VWVW'IOWa{ ot.gOV Office of Driver Services PO Box 92041 Des Moines,IA 50306-9204 Phone:515-244-9124 i 800-532-1121 i Fax:515-239-1837 www.iowadot.gov Certified Abstract of Driving Record Inquiry Date: 8/29/2017 DL/ID #: 239CC5786 (IA) CDL Permit Class: None Customer#: 2159919 Class: B CDL Permit Issue None Date: Name: Brown, Nathan Randall Audit#: 9858247 CDL Permit None Expiration Date: Address: 3175 HIGHWAY 22 LOT 22 Issue Date: 03/15/2016 CDL Permit None Endorsements: Expiration Date: 03/06/2021 CDL Permit None Restrictions: City/State: RIVERSIDE, IA 523279601 Endorsements: NONE ID Status: None Mailing 3175 HIGHWAY 22 LOT 22 Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: VAL Mailing RIVERSIDE, IA 523279601 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 3/6/1980 CDL Cert Status: Excepted Interstate Sex: M CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation JUR County 09/11/2014 01/08/2015 M14 Fail to Obey Traffic Sign/Signal IA Johnson Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date JUR Case Number 10/04/2013 ;760447 Name: Brown, Nathan Randall DL/ID: 239CC5786 (IA) 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. A In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ar�Io his dalT C-]-CNI rat gs�IOWAI� • 8/29/2017 / L :: ,l p•'••••'•. � Office of Driver Services tJb1 � � Iowa Department of Transportation Name: Brown, Nathan Randall DL/ID: 239CC5786(IA) Aug. 3. 2017 2: 53PM Div of Criminal Investigation DCI IobiNo. 4111 P. 1/6 o7n.oi ,..A i 40. 4.1.1rn.> 4.. • r 1.'1 .9 STATE OF IOWA .,,, y..• • 7. -r.- - 1 ,.•I •• •• Criminal History Record Check n►1Request Form k . PC- • DCI Account Number:, 'I353- (lf.pplle.btc) To; Iowa Division of Criminal Investigation From A VL'r5 —1-44‘ Support Operations Bureau,In Floor �1 �l t+tr.s C),.•-• 21 S L 7`Street A Des Molars,lowa 6030 • Ws. i. 5* -4>9 Q (S15)725-60$0 Fax (4 33?' : Phoac: Faxt . - 31 R 551-8;1' _.. I am requestingIowa Criminal Histo Record Check one Last Name (min& First Name(mandatory) Middle Nainsb ►,,m ace) f- roui A. k ci \- ckA - Yckv\ c\ 1 , Date of Hirth(mL datoly) _ Gender(mandatory)._ Social Securi Number (0 - q 0I.tIYiale ❑Female L' C 1 \ 1 r 77 S/ — Walver Affirmation;Without a slgned waiver from the subject of the request,a complete criminal blstory record may pot be releasable,per Code of Iowa,Chaptor 692.2.For genjasilk criminal hirtory record information,u allowed by law,always obtain a waiver signature from the sub act of the •,neat. Waiver Release;l hecaby icivt perrnisaion for the above tnquesta)f official tD conduct an low*criminal Mowry record check with the Divbioa or Criminal lnvesdgatton(DCI). Any criminal history dui oogcenste ma ihaOsifiainminad by the DCI may be retaased as allowed by law. Waiver Slgnafur - �..�. .__ _ Io ' Crim I itis ecu d C peck email (Da use only) As of r 3' ,a search of the provided nam,and date of birth revealed: El No Iowa Criminal History Record found with DCI --1 . ,,,,,,,i. • =4 l.:o 4, Iowa Criminal History Record attached, DCI# Wit'r :. 6R, rook iv DCI initials �' DCI47(08/25/10) Received Time Jul. 28. 2017 6: 36PM No. 3762 Aug. 3. 2017 2: 53PM Div of Criminal Investigation No, 4111 P. 2/6 IOWA CRIMINAL HISTORY DCI 00682738 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- 2017/08/03 DCI:00882738 NAME: BROWN,NATHAN RANDALL DOB SEX RAC HGT WGT EYE HAIR SKN POB 19800306 M W 603 280 BLU B120 FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y SC R KNEE TAT CHEST TAT L ARM TAT R ARM TAT UL ARM CCH RECORD xww 01 ARRESTED/TAKEN IN'JO CUSTODY 20091115 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA708.2A(2) (B) DOMESTIC ABUSE ASSAULT WITHOUT INTENT CAUSING INJURY TRI(#: 1A0066I01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE; IA723.4 (1) DISORDERLY CONDUCT - FIGHTING OR VIOLENT BEHAVIOR COURT CASE I0; 06521 SRCROB9015 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1AOO86101 RESTITUTION SENTENCE DISP EFF DAT FINE $100 20100409 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 INQUIRY. DIVISION OF CRIMINAL INVESTIGATION r.� 25 r -71 1* c1-1( 1""a