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Home My WebLink About13-116 Authorization Number 13 — 1 / P - 1 (Office Use Only) 414ZP•4=111 NZ-Arit 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 Fir Ln Gm a S Middle n i e / Last1/ 017 0 h 1. Name ( '/ C' { 2. Mailing Address Co 3 ? /4 (he, )C Ci) t 7/o4 r 3. Telephone: Home Other: o' 30 q - Z S 4. Prior experience in transportation of passengers: / ' V l�Il/ �I /i•Ve 44cln C k 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? eS Type of offense Where When tv (c5 s /Ala/AlrUrt n 54 iI f y I7 ) 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? p/ Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? T e r Type of offense Where When f.e d 6nT ercf y / e1fh;- Zoi2 rc,i In r{ s kr a t re.c /3 ui t 1avc (Ay y 19P<< 2012 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 410 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) A(C 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) clerkrtaxidrivbadg 03/2013 I hereb certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number, 2 1 C C c/ s7 . 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 " mADate $7' 22//3 STATE OF IOWA ) COUNTY OF JOHNSON ) scribed and worn to before me by O r'1�Cc S -6 vI. 2 . On this a•Dsv� day of 1 } v A 0AL KELLIE K.TUTTLE -- Ye C. (. ( _. I t,-� � (- -- rnmmilssion Number 221819 Notary Public in and for the State of Iowa �i;. my Co Isslo, A�',.. _ 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). 41- / -s.,2Z- Signatur of Police Chief or designee D"ate 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. N r,i ., . ,..,1`-' \- --z_Al. SOnat, e of City Clerk or designee ate Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width)and 5 1/2" (height)and prominently displayed to all passengers. ....*...***.*...***.....*****************************************.***.************************************************************************** Office Use Only Approved application DCI report State certified driving record Website update clerkftaxidrivbadgeapp2010.doc 03/2013 IIIII Iowa Department of Transportation . . Office of Driver Services (Fail Free)800-532-1121 PO Box 9204,Des Moines,IA 50306-9204 515-244-9124 FAX.515-239-1837 Certified Abstract of Driving Record Inquiry Date: 5/16/2013 DL/ID #: 251CC0152 (IA) Customer#: 4289265 Name: Bane,Thomas Daniel Class: D ID Status: None Address: 5038 AMERICAN Audit#: 5992342 DL Status: VAL LEGION RD SE Issue Date: 05/18/2012 CDL Status: None City/State: IOWA CITY, IA Expiration 01/12/2016 CDL Cert None 522409070 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 5038 AMERICAN Restrictions: Corrective Lenses Restriction None LEGION RD SEDate of Birth: 1/12/1969 Supplement: Mailing City/State: IOWA CITY,IA Sex: M 522409070 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 06/23/2010 07/14/2010 S92 Speed 57 IIA 09/16/2010 10/18/2010 592 Speed 57 IA 09/16/2010 10/18/2010 F04 Seat Belt Violation 57 IA 08/13/2012 09/13/2012 S92 Speed52 IA 12/10/2012 01/11/2013 M14 Fail to Obey Traffic Sign/Signal 52 IA 04/01/2013 04/11/2013 F04 Seat Belt Violation 52 IA Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 07/15/2012 _ ._ 695214 IA Name: Bane,Thomas Daniel DL/ID: 251CC0152 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: --oOQ0f'' ''f�.4�4 5/16/2013 �+ IOWA :?'44 Office of Driver Services Iowa Department of Transportation Name: Bane,Thomas Daniel DL/ID: 251CC0152 • r2uMay. v..� 2013 2:31PNLabuiv ot�cyiminal Investigation 3193382708 No. 2229 YPII;S .4.;: 01.. STATE OF IOWA 1 .„'_; r t"w ` Criminal History Record Check `.. 1S- " '`fir' Request Form DCI Account Numbest 9967-F —(rapplicaalo) To: Iowa Division of Criminal Inrestigatloa From: Yellow Cab of Iowa City Support Operations/bureau,1"Floor. P.O.Box 428 215 B.7b Street Des Moines,Iowa 50319 Iowa City,IA. 52244 (515)725.6066 (515)725.6080 Fes (319)339-9777 • Phone: • Fax: (319)339-1302 I am requesting an Iowa Criminal History Record Check on: Last Name(mandrtwy) First Name(wa,daloty). • .' ' Middle Name(remo"nc dca) ' ,ANL t116M As _ PAAtiEL- Date of Birth (m,adawy) Gender oweateury) •Social Security Number cream endod) s61b., j2, )M6? await ❑Female 9es- ir-a°Si Waiver Information:Without a signed waiver from the subject otthe request,a complete criminal-history record may not be releasable,per Code allows,Chapter 692.2.For complete criminal hlstory.record information,as allowed by law,always obtain a waiver adgnatareD•om the subject of the request. • rr aivet Release:t hescby give pemistlon fix the above mgeeslbg official to conduct m town criminal himwytauad check with the Division of Ciminil Investigation(DCO. Any airing factory ems conanine ma dg is maintaned by the DCII may be released m atlovd by Isco. •Waiver Signature: I of 0'n"1-0..-- Iowa Criminal History Record Check Results (DCI ow an,y) As of -4,- /3 ,a search of the provided nam°and date of both revealed: . ® No Iowa Criminal History Record found with DCI Iowa Criminal History Record attached,DCI ii 37 0 AP-5 saD . DCiinitials • • DCI-77(00/25110) Received Time Apr. 29. 2013 3:36PM No, 1589 May. 6. 2013 2:32PM Div of Criminal Investigation No. 2229 P. 2/5 IOWA CRININAL HISTORY DCI 00370225 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 4 DATE PRINTED- 2013/05/06 DCI:00370225 NAME: DANE,THONAS DANIEL BANE,TOM DOB SEK RAC HOT WGT EYE HAIR SKN POE 19690112 M W 511 175 BRO BLK FAR IA ADDITIONAL IDENTIFIERS CCH RECORD •** 01 ARRESTED 19871227 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE 1A123-46 PUBLIC IHTOX TRK$. L33479301 CHARGE NO- 02 IA STATUTE IA719-1 INTERFERENCE WITH OFFICIAL ACTS TRK$: L33479302 CHARGE NO- 03 IA STATUTE IA723-4-1 DISORDERLY CONDUCT TRK$: L33479303 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA123.46 CONSUMPTION / INTOXICATION - 1978 CHARGE CLASS: MISDEMEANOR CONVICTION TRK$: L33479301 SENTENCE DISP EFF DAT PLEAD GUILTY 19871227 FINE $25 19971227 COURT COSTS $20 19871227 COURT DISPOSITION AGENCY: IA052015:7 JOHNSON CO DIST COURT COUNT NO- D2 IA STATUTE IA719.1(1)A INTERFERENCE W/OFFICIAL ACTS CHARGE CLASS: MISDEMEANOR CONVICTION TRIO!: L33479302 SENTENCE DIS? EFF DAT PLEAD GUILTY 19871227 FINE $10 19871227 COURT COSTS $20 19571227 COURT DISPOSITION AGENCY: IA052015J JOBNSON CO DIST COURT COUNT NO- 03 IA STATUTE 1A723.4(1) DISORDERLY CONDUCT - FIGHTING OR VIOLENT BEHAVIOR CHARGE CLASS: MISDEMEANOR CONVICTION TRO' L33479303 SENTENCE DISE EFF DAT PLEAD GUILTY 19971227 FINE $10 19871227 May. 6. 2013 2:33PM Div of Crimiaal Investigation No. 2229 V. 3/5 DCI 00370225 PAGE 2 OF 4 COURT COSTS $20 19871227 02 ARRESTED 19890507 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA123-46 PUsL10 INTOX TRIGS: 1.33479401 CHARGE NO- 02 IA STATUTE IA714-2-5 TH6PT 5TH DEGREE TRK#: L33479402 CHARGE NO. 03 IA STATUTE IA719-1 INTERFERENCE WITH OFFICIAL ACTS TRIO: 133479403 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA123.46 CONSUMPTION / INTOXICATION - 1970 CHARGE CLASS: MISDEMEANOR CONVICTION TRIO: L33479401 SENTENCE DXSP EFF DAT PLEAD GUILTY 19890508 FINE $25 19890508 COURT COSTS $20 19890508 COURT DISPOSITION AGENCY: IA0S2015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA714.2(5) THEFT 5TH DEGREE - 1976 CHARGE CLASS: MISDEMEANOR CONVICTION TRKB: L33479402 SENTENCE DISP EFF DAT PLEAD GUILTY 19890627 FINE $75 19890627 COURT COSTS $20 19890627 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE IA719.1(1)A INTERFERENCE Warner/a, ACTS CHARGE CLASS: MISDEMEANOR CONVICTION TRIO: L33479403 SENTENCE PLEAD GUILTY PINE $15 COURT COSTS $20 03 ARRESTED 19910607 AGENCYu IA0520200 IOWA CITY PD May. 6. 2013 2: 33?M Div vt Criminal Investigation iNo. /229 V. 4/7 DCI 00370225 PAGE 3 OF 9 CHARGE NO- 01 IA STATUTE IA3210-2 ORI TRK(t: L33479501 CILARGE NQ- 42 IA STATUTE IA204-4Q1-3 POSSESS WC=SOULE I/MARIJUANA TRk4: L33479502 COURT DISPOSITION AGENCY: 1A052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE 1A204.401 (3) (5) POSSESSION OF MARIJUANA CHARGE CLASS; MISDEMEANOR CONVICTION TRK41 L334735Q1 SENTENCE DI_SP EFF DAT JAIL 1D 19910826 CREDIT W/TIME SERVED 7H 199/0826 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA321J-2 OWI CRAKE CLASS; NON OONVZCffOei TRKF, L33479502 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 199/0926 DISC AAGED FROM 19924424 DEFERRED JUDGEMENT 04 ARRESTED 19950225 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA124-401 POSSESSION-9CH I TRK9; 01461910/ COURT DISPOSITION AGENCY: IAQ52Q15J JDNNSON CO DYST coGRT COUNT NO- 01 IA STATUTE IA124-204-4-M P099E99 MARIJUANA CHARGE CLASS MISDEMEANOR CONVICTION TRKi: 014619101 SUBSTANCE ABUSE EVALUATION SENTENCE 'OM EPF DAT SUSPENDED JAIL 300 19950330 FINE $250 19950330 COURT COSTS 575 19950330 PROBATION IY 19950330 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA665-4(2) CONTEMPT OF COURT May. 6. 2013 2:34PM Div of Criminal Investigation No. 2229 P. 5/5 DCI 00370225 PAGE 4 OF 4 CHARGE CLASS: MISDEMEANOR CONVICTION TRIO, 014619102 SENTENCE DISP EFF DAT JAIL 5D 19980915 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 RECDRD BUT CAN ONLY BE RELEASED TO NON-'LAW ENFORCET4ENT 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 •