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Home My WebLink About13-061.�r 1 j"=1CQ- CITY OF IOWA CITY 410 East Washington Street City, Iowa 52240-1826 -(319) 356-5040 (3 19) 356-5497 FAX First 1. Name �Y 16t ✓) 2. Mailing Address 3. Telephone: Home Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) 4. Prior experience in transportation of passengers: \) e,; Other:/ -1/9)S4/ 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense //- nrr IwA1 1 A A 4( n When i3—(o( (Office Use Only) 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? A,)0 Type of Offense Where 7. Have you been convicted of any traffic offenses in the last five years? When e Where�- When '/3 2 O�e7 P _e_ 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? �1 v Type of offense Where When Lh�(1 /o) /f It 16/ 1 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) tib 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) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) d.�.dn�b�g - 09/2012 I hereby certjUffiat I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number S/G;7- . I understand that if I falsely answer any questions in this application, that this application m y e 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) t` Signature of Applicant Dat 4144!*f 11f 44H4H11fHHfHH####f####}H;4f4f#l4414l4lif4fH4ff *!f f 1fNfHfHfH#f HfHHH#f#Hf1f f #f ff R#R#1f#flet:###4#HH##RH####H#*t##**4f STATE OF IOWA ) COUNTY OF JOHNSON 1 Tu 7bed ,and sworn , before me by �1' I Q t^- �Qf�� - On this day of Jews KELLIE K. TUTTLE 6 ��—Te -'L( to Ax a mm « o inner ��ie�s Notary Public in and for the State of Iowa • &T_4 I ?Ay Comrgis;iop Expires 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). � vY Signature of Police Chief or designee 3/1/�� 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. `- )) j "C" xi 7t"-/ 2 � Signature of City Clerk or designee ! Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update 23—Ks-4-:;3 Date cleNA ix ivbadgeapr2ot0,tl 0912012 Iowa Department of Transportation Office ofDriver Services 515-244-9124 PO Box 9204, Des Moines, iA 503DG-92N4 FAX: 515-239-1837 History Information Convictions citation Date Conviction Date Certified Abstract of Driving Record County _IUR i� -NE i D. O.T.W% -- --._...._.. fSPeed DL/ID #: 335BB7515 (IA) customer #: 1550405 Inquiry Date: 3/7/2013 ID status: None End Baron, Brtan'Mlchael Class: D TYPe... Effective _ i..__. !11/27/2011 Name: 2014 I ST Audit #: 6362290 DL Status: VAL Address: Issue Date: 10/05/2012 CDL Status: None IOWA CITY, IA Expiration 06/06/2014 CDL C None City/State: 522402039 Date: :rt Statu Endorsements: 31- CDL Med None Status: Mailing Address: 20141 ST Restrictions: NONE Restriction Supplement: None Date of Birth: 6/6/1964 Mailing City/State:. IOWA CITY, IA Sex: M 522402039 History Information Convictions citation Date Conviction Date ACD Ex Explanation.—.----.--. .. __ plana-- X592 County _IUR i� -NE i D. O.T.W% -- --._...._.. fSPeed i 08/27/2010 .09/13/2010 Sanctions End ACD Explanation--- Occurrence ]UR IUR TYPe... Effective _ i..__. !11/27/2011 �D51 Non Pa ment of Child Su por 1'... .. Support i .'- iIA IA - _,{ .. ..._.._..._.,,. IA ; Suspended__10/18/2011 _ ,.,. ,... ,�,., �- __ r,ci �Nnn-Payment of Child Support IA Name: Baron, Brian Michael DL/ID: 335BB7515 Pursuant to Iowa Code §321.10, 1, Kim Snook, ran , do hereby certify that I am the custodia of he records Director held by the Offlceffice fofrD ivereServices, that this, Iowa rts ant ue ands acrate copy of an s official record currently sIn 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: :rW41 3/7/2013 IOWA D. O.T.W% c1� pf ••...•� gtc= OBIVtA,-' Office of Driver Services of Transportation n„ Iowa Department filar. 1. 2013 8:52AM Feb. 25. 2013 1:05PM W 7D 5�it rf. ��77 f'�nn,am)� • Div of Criminal Investigation City Clerk - City of Iowa City xo; XowabivlsfonofCrtmtllatYnwesttggttoh Support opara17ovs Aurpav, VPoor zi5f;.74 areo'C bes)Y(ylnoijown $0919 (els) Tut• 6066 (616) gas -6080 Pwk R,ON No.4981 P. 7/11 No.3267 P. 2 a �yapnrp , SA •s�r F I I � � a ��vj•I�j_ i414�:� c Check ow 61CiAAf ACTAgcountN�mhep: 4UOtae. �i4omi �nYmv or TOM CTT7 cITY CzEws oaazczt• 711 Fd gFiTPIC�'oN 9TR�S1' rnrvA nYTO" Ta47d 5�24� Auk � 414-156-5M — �AXI5L97 M (C,,jgAc4. 06� ®G/�%� `� I male dJSemaTe I. 7� 8 8 �G%2 iYRdVeI' 1{/orma�'ton;Wiihou¢astgnod�S�nCyaxlYAmihesu6jeatoftttoKegaesN,veompCelBoY.ttginkihtafoYyYeaordmayrtoE bayotea9pfiTc,par, CadooCYbwa,Cha);iord92,70F co faf'crlmioal5%LaryracordlnformatfotgasalYowaJ ;yY4vi,alWays ]�[y1�/EN.�6�8/r�'�:Yh�rzLygivep9rmis9(oc.(OC1iIonEeVerequtl�IdgotlTc1Q11oCp11duptpllYo�Y0.oimina«story[¢cerdei<eekWitf�Iflopi4rsloggPeriminol YnvasUgation(paD.+�Y�imkelLfa(o�ydatd�Pnwm(ngnia,naL7s�np7ntolnedEy�fionOYmpybo2akosedavelloieedbyTnrv. . , C Wulver5t�stnlurs: �o r� Cy�iYninal ] s .off V' Z�e�ordl �T1ecS� e�YxIf� . CDC) Wo only) . . li s o£ a seatah 6f tha provlcted namo aizd date o�bnihxoveaTed: 901bura Crlminal4srotyRecord found withbCT � Xowa Criminall:TlsfpsyiteGoidattached, JDCx# bC7,lnitfa)s r � / i 11 Mar. 1. 2013 8:52AM Div of Criminal Investigation No.4981 P. 8/11 IOWA CRIMINAL 1413TORY DCI 00332760 MISDEMEANOR CONVICTIONS ONLY PAGE I OF 2 DATE PRINTED - 2013/03/01 DCI:00332760 NAME: BARON,BRIAN MICHAEL DOD SEX RAC HOT WGT EYE HAIR SKN NOB 19640606 M W 510 155 BRO BRO FAR ADDITIONAL IDENTIFIERS TAT UL ARM TAT UR ARM CCK RECORD rws '01 ARRESTED 19850522 AGENCY: XA0520400 IOWA CITY UNIV SEC PD CHARGE 90- 01 IA STATUTE IA204.401(3) PROHIBIT= ACTS TRK#: 212233201 COURT DISPOSITION AGENCY: IA052015LT JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124.401(6) POSSESSION OF A CONTROLLED SUBSTANCE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: Z12233201 TRK#: L28108001 SENTENCE SENTENCE FINE $200 02 ARRESTED 19850712 AGENCY: IA0020200 DAVENPORT PD CHARGE NO- 01 IA STATUTE IA719-1 INTBRF W -ACTS TRK#: LZBIGBO01 COURT DISPOSITION AGENCY: IA082015J SCOTT CO DIST COURT COUNT NO- 01 IA STATUTE IA719-1 INTERFERENCE WITH OFFICIAL ACTS CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L28108001 ' SENTENCE PLEAD GUILTY SUSPENDED 2D CREDIT W/TIME SERVED 3611 03 ARRESTED 19850720 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA719-1 INTERF W -OFF ACTS TRK#: 1,20188101 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA719-1 INTERFENCE WITH OFFICIAL ACTS DISP EFF DAT 19050806 DISP EFF DAT 19850029 19850829 19850829 r Mar. 1, 2013 8:52AM Div of Criminal Investigation CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L28108101 SENTENCE PLEAD GUILTY JAIL 36H CREDIT W/TIME SERVED 04 ARRESTED 1989D527 AGENCY: IA0520200 CHARGE NO- 01 GRIM MISCH 3RD TRIO: L20188201 COURT DISPOSITION IOWA CITY PD IA STATUTE IA716-5 AGENCY! IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA716-5 CRIMINAL MISCHIEF 39b CHARGE CLASS! MISDEMEANOR CONVICTION TRK#: L28188201 SENTENCE FINE $125 PAY SURCHG- DCI 00332760 PAGE 2 OF 2 DISP EFF DAT 19850829 19850829 19850629 DISP EFF DAT 19090802 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. WECANWT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No.4981 P. 9/11