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Home My WebLink About13-165 rAuthorization Number 13 " 1 C,5 _ 1 (Office Use Only) APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (Police Department review must be made 410 East Washington Street between 8 a.m.to 3 p.m., Monday- Friday.) Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX first Middle Last 1. Name _J N J Lt 2. Mailing Address ^��, i� 3. Telephone: Home:Mill--I - (151. Other: (� 4. Prior experience in transportation of passengers: J , c>\} 0` 1 i( 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 1 —� Y\CX)3 J 6. Have you peen convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When yyd\A) LTA r 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 14, 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) Ii 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) clerk/taxidrivbadg 0312013 I herebycerti tat I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license numbers .3� ��, . I understand that if I falsely answer any questions in this application, that this application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will 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 a license 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 4... I Date ► ***********************************************************....******************************************************************************* STATE OF IOWA ) COUNTY OF JOHNSON ) t bscribed and sworn to before me by 61) 0-4 L 5. In-c.L-TZ»'1 . On this g-f'� day of d' L,". . - 2-0/2) -- 24•_,e..(' ,--C /C / c � ts A, KELLIE K.TUTTLE NotaryPublic in and for the State of Iowa cy c;ommissiun i.i.rubor 121AiQ n Ex fres ...,______i ...* ,,,,,,. ..................*******.***********.....****************................................ I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City(Title 5, Chapter 2, City Code). 4. - ------ .F-ti_.3 Signature of Police Chief or designee Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. Signa e of City Clerk or designee - Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width) and 5 Y2" (height)and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update clerldtaxidrivbadgeapp2010.doc 03/2013 Iowa Department of Transportation tail) Office of Driver Services (Toll Free)BO11-532-1121 PO Box 9204,Des Moines,IA 50306-9204 515-244-9124 FAX:515-2394937 Certified Abstract of Driving Record Inquiry Date: 8/8/2013 DL/ID#: 237CC0864 (IA) Customer#: 4637966 Name: Shelton, Brian Andrew Class: D ID Status: EXP Address: 226 S LUCAS ST APT 1 Audit#: 6004564 DL Status: VAL Issue Date: 05/24/2012 CDL Status: None City/State: IOWA CITY, IA 522405153 Expiration Date: 03/18/2015 CDL Cert Status: Excepted Intrastate Endorsements: 3 CDL Med Status: None Mailing Address: 226 S LUCAS ST APT 1 Restrictions: Commercial Instruction Restriction CDL Instruction Permit Permit,Corrective Lenses Supplement: Expires 11/24/2012 Date of Birth: 3/18/1983 Mailing City/State: IOWA CITY, IA 522405153 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 06/07/2010 ;07/05/2010 592 SpeedBoone IA 06/07/2013 `07/23/2013 M14 ;Fail to Obey Traffic Sign/Signal Johnson IIA • Name: Shelton, Brian Andrew DL/ID: 237CC0864 Pursuant to Iowa Code §321.10, I, Kim Snook, 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 lc1E p\r0N F:.-0.0. . jo y\ 8/8/2013 (CJ ) SI1%., L•'••"''S�. Office of Driver Services 4, DNIVEF_-= Iowa Department of Transportation Name: Shelton, Brian Andrew DL/ID: 237CC0864 V" Aug. 7. 2013 '• 3: 17PM1 ' Div of Criminal Investigation ' No. 1883 : DP. 1/2'; •.:.' • X:: ':kUg.r 1- LVI) 'If))viva . • c•I l,r 1.••• C hithitU I I u:.—loll .•i ,I. • . 111 yi,JI r " , •' . c . ♦.. • ' 1 . 1 . . ,' .., ' ,.. ,' 4 • 1 , • 1 . 1 . • • 1 .. ••'il , • • • , 1 %40, 9.04e1$ ;," 'UY IW''4, /Y•...��-•1 J�1�ery-{y; 5�,y.�'y'y ��]' 1 1 Y5� , lY''',s*.44 1 '1 ' .STA.A.u_( 61q. i1.d1/V ' 6 ' 01 'Y • e'e' st• • • , 1r( t$ Ati �M1 .7 1 • 1 • • . P[!AeCnmitN-nrith•en .)-1 W'00 - . . • . 1 . . '. • QtbP111Cc6 ,. Toi ZotVA)ttvloCori at exiinina1Thvastlgnrlon . Woma GM o 'Ind an .. 5u}epos'topetattoriquvortur''Moor C1TY' Csurriil 08FXE , 2Z5k17'1 Strout • , y.'tO 1L. klASAr�IGTON SXP,S l )36 Mpfrtos,Xotva S031.s • (5Xa)9?Cf•6abb • ♦ • I'JWA, an Xo11A 5234D i5)125•bdeo Nat ' khone; 4Lu1p 56•-SOlr1 1hix: 4• e--956-5/s 1'' — • Xamre•uastin; anloo,Crimfnplfleto RecordClioolin»; r • Y,ast arms(mmdatol., • AdrstNallie mandato • Middle Nate UEcom•feadsal Ski+► i hA ' • Data of$list, (nmremo 0411de>:(mAnd•m, SCokfllSool>xltVMild or(reammcndea • • Iggi • ► are Qeare • 3 - 0 `09 llzdye anha 1 i iv 1iOUP.Aalgae 1pLkITT lom!•15SUI et0'toxegke,a4AC0inlaborfrlink SegYctox.moyuoa hsxaleasabte,per coaooyYawk,cfrotor50,3,IfolvvfolsvorinitnothisforyreoorcMTSmntlokxcidalfawed IyMs,grvnys , ahia&, atvorsi: a(urs1Yonrtfia,arrb,sotatthe "test; WiltY474.keiganctraniveperkls,foa@rd(dnboyarequEafnsofea91(oWf•uaf$410W4odmfndawoOm4ocdcheriovrtiJAeDbiskoa.wproiro l Y yEsdgariCA(DOD.MyuinJnelhfa(orydat oonre 1 f olhnalrnalnlalnaddgr4Tmaybnnf os 4ngllolvcdbylsty. L -i' L/ 'J� WalverSlgnalar/e 1lLu0,�J� • Y' IowaICritakcsl Mato-Rod:,o,rd C•atec egtat`g 1 ' (ovine onb9 As'of \fl \ \3 • yaseprChoftheyruvidedname' andclato•o 'IStvtthsovealecid • • 0 'ofah1 tirnCrlDoallijatoryRtecardfbrnidvdfhJCI I , . - • • �, ram Withall�• 'istoLyReCatcl Cached;Delhi' lift 3 65 l - ' Received Time Aug. 2. 2013 12:34PN•No. 238I'I,kC_•_ • Aug. 7. 2013 3: 17PM Div of Criminal Investigation No. 1883 P. 2/2 r IOWA CRIMINAL HISTORY DCI 00693657 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- DCI:00692657 2013/08/07 NAME: SHELTON,BRIAN ANDREW DOB SEX RAC HOT WGT EYE HAIR SRN POE 19630318 M B 510 230 BRO /MK MBR IN ADDITIONAL IDENTIFIERS PHOTO AVAILABLE; Y SC R SHLD CCH RECORD 't* 01 ARRESTED 20030314 AGENCY: IA0520100 CORALVILLE PD. CHARGE NO- 01 IA STATUTE IA321-561 DRIVING WAILS BARRED TRK#; 100813401 COURT DISPOSITION AGENCY: IA05201SJ JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE ID: 06521 AGCR064955 • CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100813401 SENTENCE DISP EFF DAT JAIL 9D 20030721 FINE $500 20030721 02 ARRESTED 20070213 AGENCY: 110520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA708.2(2) ASSAULT CAUSING BODILY INJURY-1978 TRK#: 1A000U401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA708.2A(2) (B) DOMESTIC ABUSE ASSAULT WITHOUT INTENT CAUSING INJURY COURT CASE ID: 06521 SRCR077844 TRK#: 1A000U401 SENTENCE DISP EPP DAT APPEAL DATE DEFERRED JUDGEMENT 20070529 PROBATION 1Y 20070529 20071129 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAI BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIF�ION 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