HomeMy WebLinkAbout17-133 ` IDENTIFICATION NO. / 7 — 13 3
1 (Office Use Only)
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CITY OF IOWA CITY APPLICATION FOR TAXICAB/MOTORIZED PEDICAB VEHICLE DRIVER
(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 /7 Middle Last
1. Name(REQUIRED) �`trT Ja ,,; Si. �1✓�
2. Address (REQUIRED) Z c. lei,e S F_ -4 5
3. Contact Information (REQUIRED) Email: /Ca-4"S (o.,,. Cell Phone: 3/ -7?)- 4/S
(All written cornmunicati6n sent via email)
4a. Driver's License expiration date (REQUIRED) )pj b
b. Taxicab Business Name (REQUIRED) Ye/'c
5. Prior experience in transportation of passengers: .VJ.i _IA- rpt
6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? y'' s
Type of offense Where When (� r
J M P l e n455,44- �` remit l� 1 , �— 201 !
/4 Cave,j,cx �v +to �I,Sc.�c// w' I , fal v I 2C D ,
What happened to the charge? (Circle one)
Core" Dismissed Deferred Suspended Plead Guilty Other
7. Have you been arrested /charged with any traffic offenses in the last five years? //21:7
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?
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 tke name(s)
•
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE.CER+ 'IED
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEV-
You must apply for an individual Department of Criminal Investigation Report(form avaftab(e upon requt).
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY):
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07/2016
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
I hrby cert' that I have issued to me by the Iowa Department of Transportati n valid Drivers license number
f W,4I J I I I issued onefi/Zt/2o/?expiring on g93//hi/2Z2-7.--.Z. 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 T le 5, hapter 2, of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant .► 1 ! Date �7–20 I
************************************************************************************************************************************************
STATE OF IOWA
COUNTY OF JOHNSON )
Subscribed and sworn to before me by on this a day of
sem, . .
atKENDY
__S._ Notary Publi lin and or the State owa
Erpr"
*****************************************************************************************************************************A A A AA*k************
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).
Expir.•tion dat- • 'rive- license 3/ RI/ Z r
41!
1 20
Sig . re of Po 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.
_ . -�
Si. o /
..ture of City Cle k y esignee Date
*************4 ***k******************** **************************H**** +i4 ******A AA A Ak************
Office Use Only 't rn
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Approved application –.1n
DCI report --0 rn
State certified driving record —
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Website update (f.)
Clerk/TAXIDRN8ADGEAPPL92014amended.DOC 07/2016
. Sep. 19. 2017 8:52AM Div of Criminal Investigation No. 1316 P. 8/10
From:CI%y of Iowa city clerk Off loo 319 36(55 4.97 OA/14/20,7 10:69 42222 p.002/002
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awe ` Criminal History Record ••.'1,..0. ,` u . Request Form .\ 1_ .
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-- -- _ _ DCI Account Number': _-/ c Z l:
(ii'plierhle) -_—
To: luwa Division of Criminal Investigation •
From: _City of Iowa C'.itY
5tipport Operations Bureau, 1"Floor —..w..___,
Ciiy Cleric's
235 E.7'I' street Office
910 E.Washington Street
Des Moines,Iowa h0319
__ (515)925-(i066 lat _City, IA. �.zo
(515)725-6080 Fax — ,__=.—_m__
Phone: 319-356-5041
Far: 319-356-5497 `—"__ ___
1 ar11 re uestin_ 3n Iowa Criminal Histol Record Check on:
Last Name (mandatory) First Name(msndatory) Midltile am�r,._,,---,,.,,,i, _
4).614-
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Date of Birth(mandatory) Gender(mandatory) Social Security (rccominended)
D.3-- I y — '7 7 ' I late DFemaie Z.Z. ?— /9 — if)/ .
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Waiver information: Without a signed waiver from the subject of the request,a complete criminal history record may not
be releasable,per Code of Iowa,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.Release!i herchy g.ivo permission rpt r re.rruesriva.otticia ro•conduet-anaeaw-oriminaFfihtorrrccord-clret - t tenth iston or Fir ,nal
Investigation(DCI). Any criminal history data concerning t al Is maintained by the PCI may be released as allowed by late.
Waiver Signature: —
lowa_er'rimlinal Hfs Record Check Results
/� /�, (DCI use only)
As of —/ ' t1 "7 17—, a search of the provided name and date of birth revealed: .
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No Iowa Criminal History Record found with DCX � `• ._' `moi
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(7)''.< C,7 i
0 Iowa Criminal History Record attached,DCI# yr-' M
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DCI initis z ••
Received Time See. 14. 2017 10:39AM 11n. 6746
i
1E • State of New Hampshire PAGE
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Department of Safety
Division of Motor Vehicles
..,,:,,,....7./.72f..,,--133 SEARCH DATE 1
2% 23 Hazen Drive, Concord, N.H. 03305
JOHN J. BARTHELMES Elizabeth A. Bielecki
Commissioner of Safety Director of Motor Vehicles
08/24/2017
DRIVER RECORD REPORT
REQUESTING AGENCY:
BRET SWAIN
512 S DUBUQUE ST #8A
IOWA CITY IA 52240
DRIVING RECORD OF: Date of Birth DMV File Number
SWAIN BRET J 03/14/78
238 N MAIN ST ID NUMBER: 03SNB78141
CONCORD NH 03301
CERTIFIED COPY SHOWING CONVICTIONS, ACCIDENTS AND MOTOR VEHICLE ACTIONS
NOT UNDER SUSPENSION OR REVOCATION AS OF THIS DATE.
NO PROOF OF FINANCIAL RESPONSIBILITY IS REQUIRED.
ADDRESS SHOWN REFLECTS MOST CURRENT ADDRESS APPEARING
ON THE FILES OF THE DIVISION OF MOTOR VEHICLES.
*** LIC ISS : 08/12/2016 LIC EXP : 03/14/2021 ***
*** LICENSE CLASSIFICATION : OPERATOR ***
********************** END OF HISTORY FOR INDIVIDUAL **********************
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CERTIFIEDP R &CgtECT
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Director of Motor Vehicles
Refer Phone Inquires:603-227-4010
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VERMONT
State of Vermont Agency of Transportation
DEPARTMENT OF MOTOR VEHICLES [phone] 802-828-2000
120 State Street [toll free] 888.99,\TERMONT
Montpelier,VT 05603-0001 [fax] 802-828-2098
dmv.vermont.gov [try] 711
PAGE: 001
08/21/17
I HEREBY CERTIFY THAT THE FOLLOWING IS A TRUE COPY OF THE 3-YEAR RECORD OF
NAME : SWAIN, BRET, J VERMONT PID: 31672953
ISSUE YEAR: 2011
BIRTH DATE : 03-14-78
LICENSE EXP DT:
NO VERMONT LICENSE, NOT SUSPENDED , ENDORSEMENTS-
NO ACCIDENTS
NO CONVICTIONS/ADJUDICATIONS
NO SUSPENSIONS/REVOCATIONS/DISQUALIFICATIONS
JRSUANT TO THE DRIVER PRIVACY ACT OF 1994 , 18 U. S .C. SECTION 2721 ET SEQ. ,
THE DISCLOSURE OR REDISCLOSURE OF PERSONAL INFORMATION OBTAINED FROM THE RECORDS
OF THE DEPARTMENT OF MOTOR VEHICLES MAY BE A VIOLATION OF FEDERAL LAW.
IN TESTIMONY WHEREOF, I HAVE HEREUNTO SET MY HMD AiiMONTPELIER, VT.
TWENTY FIRST DAY OF AUGUST-) , 017 .
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Iowa Department of Transportation
ir Office of Omer Services (loll Free)800-532-1121
I PO Box 9204,Des Manes,IA 50306 9204 515-244-9124
FAX=515239.1831
Certified Abstract of Driving Record
Inquiry Date: 9/20/2017 DL/ID #: 186AN1911 (IA) Customer#: 6639960
Name: Swain, Bret Jamie Class: C ID Status: None
Address: 512 S DUBUQUE ST Audit#: 2084546 DL Status: VAL
APT 8A
Issue Date: 08/22/2017 CDL Status: None
City/State: IOWA CITY, IA Expiration Date: 03/14/2025 CDL Cert Status: None
52240
Endorsements: NONE CDL Med Status: None
Mailing Address: 512 S DUBUQUE ST Restrictions: Corrective Lenses Restriction None
APT 8A Supplement:
Date of Birth: 03/14/1978
Mailing IOWA CITY, IA Sex: M
City/State: 52240
History Information
CLEAR DRIVING RECORD
Name: Swain, Bret Jamie DL/ID: 186AN1911
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:
,� f 16 IS 9/20/2017
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Iowa Department of Transporation
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Name: Swain, Bret Jamie DL/ID: 186AN1911CD(—) "'
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