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Home My WebLink About18-116tai CITYF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-SO40 (3 19) 356-5497 FAX Last 1. Name (REQUIRED) I IDENTIFICATION NO. (PLLT ) 10 (Office Use Only) t APPLICATION FOR TAXICAB / MOTORIZED PEDICAB,VE6?CLE k)RWER (Police Department review must be made between 8 a.m. to -3 p.ma Mond- Friday) _ t Failure to complete the "required" information will result in deniaFe the ffi blication f) ,o First Middle 2. Address (REQUIRED) 1e=rp �[y p AAS, zA 3. Contact Information (REQUIRED) Email: ZQNe L \-q I L,ahL� . nt✓\ Cell Phone: 31 r1- 3 3 YU�S (Ali written communication sent via email) 4a. Driver's License expiration date (REQUIRED) - 13 - a-�C b. Taxicab Business Name (REQUIRED) /6VoLj (C 5. Prior experience in transportation of passengers: 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 6t�)y r�rui )f What happened to the charge? (Circle one) Convicted Dismissed Deferre Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? /VU Tyne of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? �tLS Type of offense Where When _(9cj;z 1--,:) d 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) 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 hereby certify that I have issued to me by the Iowa Department of Transportation a valid Drivers license number D 13 YY 5 aet(A issued on 3 -LD- tRexpiring on Ca -13 d�I understand that if 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 of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant<�_ Date Ind - Y5 - [Z STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by y, terI }l a on this /w day of �Pt,e�� vlt3 I have reviewed this application, DCI report, and the State certified driving record of this applicant and have det", 'ned that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfA4 of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). —x Expiration dat2Chief _� Signature of Podesignee pate 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. Of City Office Use Only Approved application DCI report State certified driving record Website update Date OWWT IDRMIADGEAPPL9201M�Doc 04/2018 '•,IOWA DOT www.iowadotgov SMARTER I SIMPLER I CUSTOMER DRIVEN Drfwr 8 IrNnHficat;ort NMI»t PO Box 92041 Des Moines. IA 50306.92D4 Pliale: 515.244-91241 Fat: 515.239-1837 Inquiry Date: Customer Name: 12/6/2018 5008902 Certified Abstract of Driving Record DL/ID #: 713YY5294 (IA) CDL Permit Class: None Class: C Butler, Benjamin Mathew Audit #: 2677186 Address: 155 SJONES BLVD City/State: NORTH LIBERTY, IA Convictions Issue Date: 03/29/2018 Expiration 06/13/2026 Date: Endorsements: NONE Restrictions: NONE Restriction None Supplement: History Information CDL Permit Issue None Date: CDL Permit 523179510 Mailing 155 S JONES BLVD Address: None Mailing NORTH LIBERTY, IA City/State: 523179510 Date of 6/13/1992 Birth: EXP Sex: M Convictions Issue Date: 03/29/2018 Expiration 06/13/2026 Date: Endorsements: NONE Restrictions: NONE Restriction None Supplement: History Information CDL Permit Issue None Date: CDL Permit None Expiration Date: JUR CDL Permit None Endorsements: Under 21 -Alcohol Content .02 but less than .08 CDL Permit None Restrictions: A98 ID Status: EXP DL Status: VAL CDL Status: None CDL Permit ELG y Status: ry -T7 CDL Cert Status: None C� r 1 7 CDL Med Status: Nope O 7itation Date Conviction Date ACD Explanation JUR County )6/16/2013 10/07/2013 A20 Deferred Judgment OWI IA Johnson Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence ACD Explanation JUR County 71/19/2011 A61 Under 21 -Alcohol Content .02 but less than .08 IA ,Johnson )6/16/2013 A98 OWI Test Failure IA Johnson Sanctions rype Effective End ACD Explanation JUR Occurrence JUR 2evoked 01/30/2011 03/30/2011 A61 Under 21 -Alcohol Content .02 but less than .08 IA IA 2evoked 06/27/2013 12/23/2013 A98 OWI Test Failure IA IA Name: Butler, Benjamin Mathew DL/ID: 713YY5294 (IA) Pursuant to Iowa Code §321.10, I, Darcy Doty, 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: Butler, Benjamin Mathew DL/ID: 713YY5294 (IA) 12/6/2018 6— Driver & Identification Services Iowa Department of Transportation rn N P CO = W r rn 0 �O .pror/ec. IG [V10,IV; 11"ICIer0bl 1U"M 310 56456497 1208/2010 is:v,no. 4/9 -ao r. 1312/002 STATE OF IOWA Cl-lllllual History Record (Check is Request Form To: Iowa Division of Criminal Investigation Support Operations Bureau, I" Floor 215 E. 7" Street Des Moine$, Iowa 50319 (515) 725-6066 (515)725-6080 Fax lam reauestinr. an /nava f riminal Vliee.,3.3 R Ar.~A rh.t..,..- DCIAccountNuinber: (ifapyliabk) From: city0110 ws city City Cleric's Office 410 E. Washington Street Iowa City, lA 52240 Phone: 319-356-5041 Fax: 319-356-5497 last Name nnndatay) I First Name (mandmoo AL'ddle Name (rMommeadcd) B Ui&,r 8W VOL(41AIIJ Date of Birth (mmdawrr) Gender (mandatory) Number (rmgmmended) :90cialSecuri 06-{5'iuu�- mkale ®Female -31 !2 Waiver Information: Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record Information, as allowed bylaw, always obtain a waiver signature from the subject of the request, Waiver Release: l hereby give pvmission forme above mquesiing official to condoet an tom criminal hinory record ehcekwilh the Division ofCrininal Investigation (DCI). Any criminal hislory data wncemilg me that Is maintained by list DCI may be mlased as allowed by law. Waiver Signatur� DCI -77 (08/25/10) Received Time Dec. 6. 2018 3:04PM No.4015 Iowa Criminal History Record Check ResultsCO 'j;;', As ofa search of the provided name and date of bath re4�w: ":A. ® C -t No Iowa 0iminal history Record found with DCI M IF Iowa Criminal history Record attached, DCI # C�% 3 5 l b C=) tD DCI initials DCI -77 (08/25/10) Received Time Dec. 6. 2018 3:04PM No.4015 rU a C. IL. LV 10 IV: ILHIVI Ubl IDPH IOWA CRIMINAL HISTORY DCI 00983531 NOW CONVICTION PAGE 1 OF 2 DEFERRED JUDGEMENT DATE PRINTED - 2018/12/12 DCI:00983531 An arrest without disposition is not an indication of guilt. This record NAME: BUTLER,BENJAMIN MATHEW maintained by the Iowa Division Of Criminal Investigation, Bureau Of,. DOB SEK RAC RGT WGT EYE HAIR SKN POB 19920613 M W 601 190 BLV SAO FAR IA ADDITIONAL IDENTIFIERS TAT BACK TAT CHEST TAT L 3HLO TAT R SHLD PHOTO AVAILABLE: Y CCH RECORD +++ 01 ARRESTED/TAKEN INTO CUSTODY 20130616 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE, IA321J.2(A) OPER VEH WH INT (Owl) / IST OFF TRK#: 1A00rY301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J,2(2)(A) OPERATING WHILE UNDER THE INFLUENCE IST OFFENSE COURT CASE ID: 06521 OWCR102067 CHARGE CLASS: NON CONVICTION TRK#: IA00GY301 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT $625 CIVIL PENALTY, SAE 20131007 COMPLETED h 48 -HR OWI WKND COMPLETED PROBATION lY 201310D7 UNSUPERVISED PROBATION, INFORMAL PROBATION REVIEW 05/01/14 NO. 4171 r. Z N DISCHARGED FROM 20140605 c DEFERRED JUDGEMENT rn An arrest without disposition is not an indication of guilt. This record maintained by the Iowa Division Of Criminal Investigation, Bureau Of,. `—IdefiEifcetiio-H—is auB'117creobF117 ut—can only be rel -exam I 1W — enforcement agencies by the DCI. pp�� 0 �D rJeC. 11. [Via IV: item uLi IVWA No, 401 Y. 3 This response can only include public criminal history data. Under Iowa law, most juvenile records are 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 be filed pursuant to Iowa Code section 232.147(18). Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry: http://www,iowasexoffender.com/ . However, even though some information is available on this mite, the 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). 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 tueC. IL. LVID IV: I]HIYI Al lvnh 11 01 4171 r. 4 DISCLAIMER this response can only include public criminal history data. Under Iowa law, most juvenile records are confidential. Confidential juvenlle court records, if any, cannot be included In this response. A signed release authorization is not sufficient to obtain this information from the Divlslon of Criminal Investigation. 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). Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry. htto://www.lowasexoffender,com/. However, even though some information Is available on this site, the actual records forjuvenlles 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 fowa Code section 232,147(18),