The URL can be used to link to this page

Home My WebLink About13-141 Authorization Number /3 1 (Office Use Only) __. tilt 41,4 •Polital Tit ilia I. MIM® �� 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 t,1 ( Fit Rd�y�lee I l Last cti 1. Name C 2. Mailing Address 2-0k S�IU Tr0A\ (-4 \O 3. Telephone: Home 3 N _100._ ( g 7 Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense t Where When i?A321 c- LoocA 6. Have you en convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? 0 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? (e c Type of offense Where When SPQQ3.;/ ser) ^^ i o .1% 17 - 2�,- Zv `' % U� A5ur0.Kc�0cfcJi r. U— 0. � � j °a `� 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? NO Type of offense Where When 9. Have ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) U 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) clerWtaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number Z C C -(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 tim ,nth 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 Date . STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by ill cI.1F44,v 3, p�„� . On this l day of �0 3 SONDRAEFORT 2r Commission Number 159791 So d p,{ F7 • ^w • My Commission EExpires Notary Public in and for the State of Iowa 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). zi Signat of 'oli C ref 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. 7 / - / J Signature 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'/2" (height)and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update clerWtaxidrivbadgeapp2010.doc 03/2013 Jun. 28. 2013 1:53PM Div of Criminal Investigation DCI lottNo. 8702 P. 1/2 J .►A STATE OF IOWA '`c`lvpstl4,,,In or 's Criminal History Record Check 2 Iowa �� \rr�-rir Request Form yet m r4 , DCT Account Number:4383—FC Of applicable) TO: Iowa Division of Criminal Investigation From: Marco's Text Support Operations Bureau,1"Floor 116 Stevens Dr. 215 E.71h Street Des Moines,Iowa 50319 Iowa City,la 52240 (315)725-6066 (515)725-6080 Fax (319)3315294 ' Phone: Fax: (319)351-8294 I am requesting an Iowa Criminal History.Record Check on: Last Name(mandatory) First Name(mandatory) Middle Name(recommended) Date of Birth(mandatory) Gender(mandatory) Social Security Number(narummended) 3-Co - 130L`aNllale OFemale LIES- II -77 31 • 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:thacbygive permission curiae abov. totingonldpl to conduct m Iowa exhaled history record check with the Division 0MCimind Inveeligaion Incl. Any criminal historydalamnm.• : a mainWnc4 by the DCI maybe released as showed bylaw. Waiver Signatafe: .rte• Iowa Criminal History Record Check Results (liCl vsi only) As of 4..,2p,13 , a search of the provided name and date of birth revealed: . ❑ No Iowa Criminal History Record found with DCI • Iowa Criminal history Record attached,DCI# O 1�3-31 DCI initials DCI-77(08/25/10) Received Time Jun. 25. 2013 12:29PM No. 7112 Jun. 28. 2013 1 :53PM Div of Criminal Investigation No. 8702 P. 2/2 IOWA CRIMINAL HISTORY DCI 00882738 MISDEMEANOR CONVICTIONS ONLY PANE 1 OF 1 DATE PRINTED- 2013/06/28 PCI:00882738 NAME: BROWN,NATHAN RANDALL DOB SEX RAC HOT WGT EYE HAIR SKN POB 19800306 M W 603 280 BLU BRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y SC R KNEE TAT CHEST TAT L ARM TAT R ARM TAT UL ARM CCH RECORD +•• 01 ARRESTED 20091115 AGENCY; IA0520200 IOWA CITY Pb CHARGE NO- 01 IA STATUTE IA708.2A(2) (B) DOMESTIC ABUSE ASSAULT WITHOUT INTENT CAUSXNG INJURY TRIO: 1A0006I01 COURT DISPOSITION AGENCY: IA052015,1 JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA723.4(1) • DISORDERLY CONDUCT - FIGHTING OR VIOLENT BEHAVIOR COURT CASE ID: 06521 SRCR089015 CHARGE CLASS; MISDEMEANOR CONVICTION TRK#: 1A0086I01 RESTITUTION SENTENCE DISP EFF DAT FINE $100 20100409 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON-LAW ENFORCEMENT AGENCIES BY THE DCI, IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVE:...', SUBJECT OF YOUR INQUIRY, DIVI$I. OF CRIMINAL INVESTIGATION Iowa Department of Transportation Office of Driver Services (Toll Free)800-532-1121 PO Box 9204,Des Moines,IA 50305-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 6/19/2013 DL/ID#: 239CC5786 (IA) Customer#: 2159919 Name: Brown, Nathan Randall Class: B ID Status: None Address: 707 W 9TH ST LOT 76 Audit#: 6933634 DL Status: VAL Issue Date: 05/09/2013 CDL Status: VAL City/State: • TIPTON, IA 527721461 Expiration Date: 03/06/2016 CDL Cert Status: None Endorsements: NONE CDL Med Status: None Mailing Address: 707 W 9TH ST LOT 76 Restrictions: Commercial Instruction Restriction CDL Instruction Permit Permit Supplement: Expires 11/9/2013 Date of Birth: 3/6/1980 Mailing City/State: TIPTON, IA 527721461 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 11/10/2008 12/23/2008 592 Speed 92 IA 03/07/2009 07/13/2009 B64 No Insurance Card 48 IA Name: Brown,Nathan Randall DL/ID: 239CC5786 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: o4t.e `a .ICIFp�� 6/19/2013 30: IOWA ;4y 94eilleMICSO Ir��etr..g Iowa Department Office of of river Services Name: Brown,Nathan Randall DL/ID: 239CC5786