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Home My WebLink About13-010� r -4 CITY OF IOWA CITY 410 East Washington Street Iowa Ci Iowa 52240- 826 319) 356-SO4 ijll (319) 356-5497 FAX First 1. Name 2. Mailing Address 6 IU 6Cr Authorization Number / �—%(J (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday – Friday.) 3. Telephone: Home � Q � 3O `V.26S" 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? Tvpe of offense Where When �iV If 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? h o Tvpe of Offense Where 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When When 8. Has your drivel's license or chauffeur's license been suspended or revoked in the last five years? ho Type of offense Where When 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provide the name(s) 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) derk/tuidvbadg 09/2012 I hereby, certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number �GJ I understand that if I falsely answer any questions in this application, that this application maVbb 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 Date 8 12- -7 s i3 7 *********#++####****f*f**f****+++++*##+**#*******f*f********####+************f*f*f*f*******+***++**#+**+#****ffffff********++###****ffff*ffff*** STATE OF IOWA ) COUNTY OF JOHNSON Su scribed and sworn to before me by �_�,t V�_ �CC rhe ✓tkLLOn this � � day of e 20 1 �j s KELLIE K. TUTfLE Notary Public in and for the State of Iowa �,� CwrMy co rel ss-10bExpims78 }m�- Afiy Commissio/(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). Sigrfature of P lice Cjtbf 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. 2� SignAture of City Clerk or design Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update /O —/ Date derkAezidrivbadgea 2010.doc 09/2012 Page 1 of 2 CX Iowa Department of Transportation Office of Driver Services (To11 Free) ODU-532-1121 PO Box 9204, Des Moines, !A 5030&9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/9/2013 DL/ID #: 428XX5561 (IA) Customer #: 3394935 Name: Brenneman, Seth David class: D ID Status: VAL Address: 618 N GILBERT ST Audit #: 6600388 DL Status: VAL Issue Date: 01/09/2013 CDL Status: None City/State: IOWA CITY, IA Expiration 11/08/2013 CDL Cert None 522451928 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 618 N GILBERT ST Restrictions: Corrective Lenses Restriction None Date of Birth: 11/8/1983 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522451928 History Information Convictions Citation Date 103/21/2007 Conviction Date 06/19/2007 ACD Explanation County A20 Deferred Judgment DWI :52 JUR IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence 03/21/2007 ACD A98 Explanation JUR 1OW1 Test Failure rIA Sanctions Type Revoked Effective End 05/10/2007 11/05/2007 ACD Explanation _Occurrence JUR :ASIS OWI Test Failure IA JUR :IA Name: Brenneman, Seth David DL/ID: 428XX5561 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: �tNClf OQpy i�'y 'tr IOWA tr 1/9/2013 1/9/2013 Cll�-M Office of Driver Services Iowa Department of Transportation Name: Brenneman, Seth David DL/ID: 428XX5561 Page 2 of 2 1/9/2013 i ,Jt 17. 2013 4:25PM Div of Criminal Investigation Jan. ll. 2013 3:30PM City Clerk - City of [owa City (hri milnat.mstoryRecoird Cheer' Repeat Form TO: XoWaIM919iohorC>amiaalAwB4lg0fort SupportOpeeallonsAR OA%141$Your 2x99 I ' Streoi best ables,101VA so�19 (sir) 7zn•6966 (815)123.6090 krare X dm t'eauavtin� an.7oWA G'Iminal Flls[ory Record Check No.0289 P. 1/9 No. 3132 P. 2 pCiAcoounEN'umber: /'-'�' (J ' peeppuoaer�i� VOW PITT OT TDA C£9YY cm awls OIr$SCE 47O F crAAtt1'MGTnPY S�Rtt,�T IOVA CITY TOVA, 52240 PhoeAr aig_a��_5n�t log, osI lq �3 rasa d�emala �2 -13 - gG'-� 'nlve> bo roleasab�loa, rrotractloodrer1ofWXlotyhoutCahasp(gear l6xa,t3Vevfromthosubjceioftharegttesh,gcomplefocl(�nlnpIhlsfoYyreoordntgy)1aC eonmiota'crinr[nal history record lnrormaifon, as alTnwed Dy JtrYr, GIWAys YirniYet TZeCen9s;no Irywolraatoa (DO. Any orlr WY Iyer to roudua(wt Iowa orimfntl fitsmryrecard fiuktvnh theDtiislon otCrfminal r rBa DQj+��y 6a rchdVcdAs slfowcd DylhW. 11 r Iowa Crinibffl Wstory RecoxcY Cheekeslli% 2 As of �� ' � 3 , a aeavoh of th000vld'ed name and dolo ofbixWowalod CJ No IowaCilmhialTiistoxyRecordfound w1&DCT ! . 1 Yom CEHnallliatoryRecoxd atf4*d, ncx# �- g O 30N MIX RrrrivaA T aa'o.lao 11 9011 I•IOPM Nn QOA; J � r.17. 2013 4:25PM Div of Criminal Investigation DCI:00799362 NAME: BRENNEMAN, SETH DAVID DOB SEX RAC 19831108 M W ADDITIONAL IDENTIFIERS 01 ARRESTED 20070321 AGENCY: IA0520400 CHARGE NO- 01 OPER VSH WH INT OWI TRK#: 1A0011L01 IOWA CRIMINAL HISTORY DCI 00799362 NON CONVICTION PAGE 1 OF 1 DATE PRINTED - 2013/01/17 HGT WGT EYE HAIR SKN POB 602 185 GRN BRO FAR IA PHOTO AVAILABLE: Y CCH RECORD *** IOWA CITY UNIV SEC PD IA STATUTE IA321J.2 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321J,2(A) OPER VEH WH INT (OWI) / IST OFFENSE COURT CASE ID: 06521 OWCRO78953 CHARGE CLASS: NON CONVICTION TRK#: lAO011LOI DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DEFERRED JUDGEMENT PROBATION lY DISCHARGED FROM DEFERRED JUDGEMENT DISP EFF DAT 20070619 20070619 20071210 No.0289 P. 2/9 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 DCS, IN THE ABSENCE OF FIND RPNTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION F ED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF MR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION