The URL can be used to link to this page

Home My WebLink About14-015 Authorization Number / L/ — � `) 1 (Office Use Only) �-- fir 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 -- 2. Mailing Address G 6 (v 6 , l6 {,/ `7 Z6 5 3. Telephone: Home � ; - `- ° Other: 4. Prior experience in transportation of passengers: G 4 6 di, \ 1 CZ' 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? (J' Type of offense Where When 6. Have you been 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? rU c7 Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? / I O 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) Po 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) 03/2013 I hereby f �ce ify that I 5 issued to me by the Iowa Department of Transportation a valid Chauffeur's license number X X 1 . I understand that if I falsely answer any questions in this application, thaf 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 S c-.-Z-----7 Lf ----'N-- Date CD t' /Z / I I ************************************************************************************************************************************************ STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by3---\-k--, A ,v:2. �� exn ti vu . On this 3 day of ---. 6.�„ gw- .) ate(Lk . \Notary Pub 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). __.,13"—g _ Sign re of Po c; 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. fi&e-d�. -e - U /- a 3 _ / Sign ture 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 1/2" (height) and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update derk/taxidrivbadgeapp2010.doc 03/2013 filIowa Department of Transportation l Office of Driver Services (Toll Free)800-532-1121 1111111101 PO Box 9204,Des Moines,IA 50300-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/23/2014 DL/ID#: 428XX5561 (IA) Customer#: 3394935 Name: Brenneman, Seth David Class: D ID Status: EXP Address: 618 N GILBERT ST Audit#: 7543676 DL Status: VAL Issue Date: 11/20/2013 CDL Status: None City/State: IOWA CITY,IA 522451928 Expiration Date: 11/08/2018 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 618 N GILBERT ST Restrictions: Corrective Lenses Restriction None Date of Birth: 11/8/1983 Supplement: Mailing City/State: IOWA CITY, IA 522451928 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 03/21/2007 -____ — __ '06/19/2007 A20 Deferred Judgment OWI Johnson IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence ACD Explanation JUR 03/21/2007 A98 ,OWI Test Failure IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Revoked 05/10/2007 11/05/2007 A98 OWI Test Failure IA 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: Qw .."oQ ...... /`A 1/23/2014 IOWA sl a� r ;°waD. O. T. � ,I',�C7es ..Oim% Iowa Department, Office of Driver ervic Transportation Name: Brenneman, Seth David DL/ID:428XX5561 Jan, 21. 2014 . 4: 05PM Div of Criminal Investigation ,No. 7218 P. vjn, .v. to i-r IL,J/im laity vieln vitt' vi Jona vary s g . , - . <„,,,a,�r STATE OF IOWA `'li,,- 5 r 1L �� Criminal ][)1i�tory Record Check3 (c, �lownl ir =1 Z'i ''o `kt4 yr 'Request 'or°m ; . .f t I / T-1 f dxxt • • DCT Account Number: 4°°a F (if applicable) - To: Iowa Division of Criminal Investigation From: City of Iowa City _ Support Operations tureen,1”Floor City Clerk's Office 2150,71h Street 410 E.Washington Street Des Moines,Iowa 50319 (515)725-6066 Iowa City, IA 52240 (515)7254090 Fax Phone: 319-356-5041 Fax: 319-356-5491 • X mn requesting an Iowa Criminal History Record Check on; Last Name (mandatary) First Name(mandatog4 Middle Name(recommended) • j(t.014(kva/t -S<tR I', It-( ()A 4 Date of Birth(mandatory) Genddeer(mandatory) Social Security Number(recommended) I I /O 4 6 (9.S e- �IM[aie l7Femalo �7 N f l ✓ r S6 1± 5 Waiver information:Without a signed waiver from the subjectof the request,a complete criminal history record may not be releasable,per Code of Iowa,Chaplet•6912,rot•complete criminal history record information,as allowed by law,always obtain a waiver signature from the subJect of the request. WaiverRelease:Ihereby give',oblation Thr the above requesting official to conduct an Iowa criminal hislory record cileckwih tho Division ofCrfminel Investigation(DCO. Any almlaal history dalaconaming nu,that Is maintained 6 e� DC ay be released i•lowed • Waiver Signature; r 1 Iowa Criminal Jjistory Record Check RestilS (DCI us;only) c As of (—2A- I4 , a search of the provided name and date of birth revealed: --- ` 07 T's nuc x 0 No Iowa Criminal History Record found with DCI .h . :,-.rt .iir J Iowa Criminal History Record attached,lDCI It 719 362_ ,N.,: r. DCI initials iSii ' -) J • Received TimelJan. 16: 7;2014 12: 38PM No. 0819 1� 1 . 21. 2014 4: 05PM Div of Criminal Investigation No, 7218 P. 2 • IOWA CRIMINAL HISTORY DCI 00799362 NON CONVICTION PAGE 1 OF 1 DATE PRINTED- DCI100799362 2014/01/21 NAME: BRBNNBMAN,SETH DAVID DOB SEX RAC HGT MGT EYE HAIR SRN POB 19831108 M W 602 105 GRN BRO PAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED 20070321 AGENCY: IA0520400 IOWA CITY UNIV SEC PD CHARGE NO- 01 IA STATUTE IA321J.2 OPER VEH WH INT OWI TRIO: 1A0011L01 COURT DISPOSITION AGENCY: IA05201SJ JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124.401 (5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 OWCR078953 CHARGE CLASS; NON CONVICTION TRIO! 1A0011L01 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20070619 PROBATION 1Y 20070619 DISCHARGED FROM 20071210 DEFERRED JUDGEMENT 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. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OP YOUR INQUIRY. DIVISION OF CRIMINAY. INVESTIGATION