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Home My WebLink About18-093CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497( (Xf_Z) W Last �JC 11 w1 1. Name (REQUIRED) 2. Address (REQUIRED) IDENTIFICATION NO. 193 _D (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) Failure to complete the "required" information will result in denial of the application 41 3. Contact Information (REQUIRED) a�6 First H Email: J�-2t� c kW, i,.w/\3 O Ino�Na.I dell � Email: � �v g Cell Phone: (All written communication sent via email) e--ZI J S' 2 3 z7 31y -4od-Q I� 7 4a. Drivers License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) C 1 0(� CU / 5. Prior experience in transportation of passengers: C" e, f O5 c^ ' J Y I l o r"I C q 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Y-` S Type of offense , k —, cid of ly c ()A3 What happened to the charge? (Circle one) Convicted (,,Dismissed 7. Have you been arrested / charged with �y UFO Type of offense C�cd i Aq Where 1W,hen r _moo r =<m4r— Deferred Suspended / lead Guil Other — offenses in the last five years? Where / When S o W" C f What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended =Plead Other 8. Has your drivers license or chauffeurs license been suspended or revoked in the last five years? No 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) I\"1 '�:> (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 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). I herebcertify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number 2 �� C <— S'18 (p issued on 3 -I 1 rp expiring on 3-6-74 . I understand that R I falsely answer any questions in this application, that this application may 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 authorization to be a taxicab driver is granted, to comply at all times with all of the provisions-af Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature ofApplican� _} Date lfffifffffN*fN*HfHH11HH*}**}fNHfff#H***N*}**fN}N1ff#Hf*N*N}}N}NIH}H#H###**fN}NfH}HH11f1##1f *#H##f *1fM}fNfHHffIH1 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by A_jcgh am_ �,. ��o��w� on this _ day of �"` wENDY S. MAYER Notary Publi6jnand for the Stat of Iowa MY iow E*ims 1— Q m I have reviewed this application, DCI report, and the State certified driving record of this applic' d e dined that there is no information which would indicate that the issuance would be detrimental to the safeD: all r welferaof resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). n cow r' M Expiration d riv s e G3-0[ro-Za Z� _ Signature gWolice Chief or designee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. un Office Use Only Approved application DCI report State certified driving record Website update — 3 c) Date aeM1/TA%ICANBADGEPPPL9201 Ba�.DOC 04/2018 QJIUWADOT SMARTER I SIMPLER I CUSTOMER ORiUEH wvw.lowadat.gov Drive a IdontReation Services PO 6cx 52}:1 Des 6xlnlm IA 513C6Y2W Pfcne 515-71.1-9t74l Fat 51G739-1897 Certified Abstract of Driving Record Inquiry Date: 8/27/2018 DL/ID #: 239CC5786(IA) Customer #: 2159919 Name: Brown Nathan Class: B ID Status: None Randall Address: 3175 HIGHWAY 22 Audit #: 9858247 DL Status: VAL LOT 22 City/State: RIVERSIDE, IA 523279601 Mailing Address: 3175 HIGHWAY 22 LOT 22 Mailing RIVERSIDE, IA City/State: 523279601 Convictions Issue Date: 03/15/2016 Expiration Date: 03/06/2021 Endorsements: NONE Restrictions: NONE Date of Birth: 03/06/1980 Sex: M History Information CDL Status: VAL CDL Cert Status: Excepted Interstate CDL Med Status: None Restriction None Supplement: Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Name: Brown, Nathan Randall DL/ID: 239CC5786 Pursuant to Iowa Code 4321.10, I, Darcy Doty, Director of Driver & Identification Services, Iowa Department of Transportation, do hereby certify that i am the custodian of the records held by Driver & Identification 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: 0 n m c— Citation Date C- C-)� w Explanation =tC 0 ry Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Name: Brown, Nathan Randall DL/ID: 239CC5786 Pursuant to Iowa Code 4321.10, I, Darcy Doty, Director of Driver & Identification Services, Iowa Department of Transportation, do hereby certify that i am the custodian of the records held by Driver & Identification 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: Citation Date Conviction Date ACD Explanation Coun UR= 09/11/2014 01/08/2015 M14 Fall to Obey Traffic Johnson � fA •' _ Sion/Signal T� Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Name: Brown, Nathan Randall DL/ID: 239CC5786 Pursuant to Iowa Code 4321.10, I, Darcy Doty, Director of Driver & Identification Services, Iowa Department of Transportation, do hereby certify that i am the custodian of the records held by Driver & Identification 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: Name: Brown, Nathan Randall DL/ID: 239CC5786 8/27/2018 C� Driver & Identification Services Iowa Department of Transporation O LD 0 s w v cn - STATE OF IOWA CriminAl history Record Check 'Request Form T0: lowa D10ilou of Cela Wallavatieation Support Qperat(pdaBurcau, I" Fiver 213 & 7't Sireel Des bldaet, Iowa 50339 (515)725.6066 (Sig.11 oo Paz I alta reoueatinc an tnwa Cri nirsl Blaney Rrrnni C'Iw Lr rn. M0319338:. _ ._:21002 DCIAccou,ll Number: ____9967 -F_ -- From: Yellow Cab of toga C tom_, P.O. Buz 428 Iowa Ctty, iw. 52:45 �._ — (319) 33&9177 Pho>oe: Felt (319) 339-7302 — N 0 `X.ISt IYamd(,w,.�b-y) - `Ti T?trat �(im0manlieain:.-.., i�iid e rn 0'6kho,ln DataotBiltlt_t,laat�r} Gender( ter) Socialsecuri be Ata le MFemaie ` o � ' � (410 01 .. j Walver fnfwrnaflon: t nheut_'. optd v.ive,,from Ifie subjeerof rba}erfoe,t, a complete cl-imloal hiNory let mry not hardeaaablq per Code of luwo, CbxpterW3.2. For So.Sl�lp criminai historyrecord iaformat(on, as allowed by law, atwaya oh(athsWa`o`,r...tvretTomtharaubicctaftherwoest.' Wotvtt R0legml.bc e%Y, V,mn .mt.nloimtri.%4W then ioirdpca with ,a;. vrvwon ofC[LT.k,i rdr�x'1:W7 roc!rki+e•ttu a:u.,4 bir:irn l: t ru1"ll IMAUTV At'`U U %-11CULLMUSURS (DClaltoafy) q i i As of a l a starch of she provided name and dare of birth revealed: :1 (� No Lowe Comuul Histo y Record found with DCT � :urs ITI Inwa Critttina! History Record attached, UCLti__ `'' '•'� DCl initials.__ -AL r DC1:77 (0925 i0) IOWA CRIMINAL HISTORY UCI 00882736 MISDEMEANOR CONVICTIONS ONLY PACE I OF I DATE P:IINTEL- DC:.00682318 2019106/29 NAME' BROWN,NATNAN RANDALL DOD SEX RAC HGT WGT CYE HAIR 5 K POB 19600306 M W 603 260 BLU SRC FAR IA ADO:TIONAL :CEN-IF:ERS PHOTO AVA:TABLE: Y SC L: 13:EE TAT CHEST TAT L ARM TAT R ARM. ,AT Ul. ARS! CCH RECORD ••• 01 ARRESTED/TAKEN INTO CUSTODY 20091'15 AGENCY: IA0520200 IOWA CITY PE CHARGE NO- 01 IA STATUTE IA7OS.2A(2?(B? DOMESTIC ABUSE ASSAULT WITHOUT INTENT CAUSING INJURY TRKO. IA0086101 COURT DISPOSITION AGENCY- IA0520:SJ JOHNSON CO DIST COURT COUS? NO- 0_ :A STA -U:£. TA723.IiI? DISORDERLY CONDUCT - P10HTINO OR VIOLENT BEHAVIOR COURT '.ASE ID. 06521. SRCR009015 CHARGE CLASS: MISDEMEANOR CONVICTION TRXI; 1AD086101 RESTITUTION SENTENCE DISP EFF :,A- F:%IE $100 20100109 'd AN ARREST WITHOUT D:SPCSITION IS NOT AN INDICATION OF GUILT. THIS RF.COHU �C-) ca a MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, OUREAU OF D� G"J IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED 'TO NON-LA4? n ENFORCEMENT AGENCIES BY THE DCI. �n C <rrn i:7 THF dR5fK"E OF FINGERPRINTS FOR POSITIVE IOENTiFTCATTCN THIS RECORD 35 S EASED ON :NFOP!?S10N FURNISHED. WE CAVNOT CG14FIRM. OR DENY THAT :H£ RECORD f� W COVERS THE 5L3JECT OF YOUR INQUIRY. fy F DIVISION OF CRIMINAL INVE--------- Ln I „ rT 0 DISCLAIMER chis response can only include public criminal hlsfory data. Under Iowa law, most juvenile records aro confidential. Confidential juvenile court records, If any, cannot be Included in this response. A Signed release authorization is not sufficient to obtain this Information from the Division of Criminal Investigation. In order to request the release of confidential juvenile records, if any, an application must bu filed pursuant to Iowa Code section 232.147(18). Additionally, criminal history data concerning convictions for certaln juvenile sex offenses can be found on the Iowa Sex Offender Registry: htto://www.iowasoxoffendor.com/. However, even though some Information is available on (Ills site, rho actual records for juveniles may still be confidential and any confidential juvenile records cannot be provided with this record. In order to request the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). N O CO rn = Q �� w D F cn