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Home My WebLink About19-007CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 3S6-5497 FAX Last 1. Name (REQUIRED) _ 2. Address (REQUIRED) 3. Contact Information (RE IDENTIFICATION NO. 101 -0(7-j (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) First Middle 4a. Driver's License expiration date (REQUIRED) _ b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: brob"e- 4�oi5i07 LdiLo O//IL/ 20Zl W Ca 12 0,(- _T a ( 14- CAA 4cad dr, re J'*el-> a rd M pvd fet Nye 44- // W' lnccaC 6. Have you ever been arrested / charged any misdemeanors and/or felonies in this State or elsewhere? YP"S What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty/ Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Y e 5 Type of offense Where When S>�P Tohnscn elch, V /o// f/ zo/," _ tt bPff- uir(a7)rn 70hn5cn fokn N7/27izo/6� 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? Tvce 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) rC/ ULJD 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). 20;5 Jt; II FIi 38 I hereby certdy that I have issued to me by the Iowa Department of Transportation a valid Driver's license number 2 S I _ � o l sy issued on 11612016 expiring on 11/2/2o 2/ . 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 l%rY ag-,ik� Date 9 fYY411Hf##!f###4411#i4111f441111N1f1114Nf14#14411f#41111##!11##411111##yf11f##11f#y#4111##4111#!Iy STATE OF IOWA ) COUNTY OF JOHNSON 1 Subscribed and sworn to before me by Tkov 5 �, 7)r4 c on this /0 day of �awu�✓'y r-ot4 . I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Drver's nse 0 1-/Z - Z- S5906re of Police 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. Of Office Use Only Approved application DCI report State certified driving record Website update Date 0erk/TAx1DPoVBADGEAPPL%201 aem¢nded.DOC 04/2018 Jan. 8.1U19 11:05PM UGI IOWA No.8346 P. 1/9 FrOrP:VIrY ui r•r v.r .,,•y CIcrK 310 BECE497 01/04/2019 18:16 7108 ..-- /002 !'-Fn Ailosi� STATE OF IQ;WA. Criminal History ReOr i Check 61 is Request Form To: Iowa Division of Criminal Invtsilgation Support Operations Bureau, 1" Floor 215 E. 7ch Street Des Moines, Iowa 50319 (515)725-6066 (515) 725-6090 Fax I sin reoueetino an Inwa rriminal IrielnN Anrnrd r9vrlr nn - DCI Account Number: �—F (if applicable) From: CityoflowaCity City Clerk's Office 410 E. Washington Street Iowa City, IA 52240 Phone: 319-356-5041 Fax: 319356.5497 Last Name (mandatory) First Name (mandatory) Middle, Name (aconin endcd7 NN T�0MCfS uJQhi� Plate of Birth (mandatory) Gender (mandatory) Social Security Number (recommended) I Z / bale ❑Female 8 r' 00 g !� 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 it waiver signature from the subject of the request, Waiver Release; I hereby give parniasim for Nc above r omring official to conduct an bwa ulmioel historyretard check with Iho Division of Criminal InvesGganon (DCI). Any criminal history data conceming me that is m■inlained by the DCl may be released as allowed by law. Waiver Signature: Iowa Criminal History Record Check Results (Dcl use only) As of If 'l a search of the provided name and date of birth revealed:S ATE OF IDWA/DPS ❑ No Iowa Criminal History Record found with DCI JAN - 7 2019 O ZZ� DIV F CRIMINAL, INVEST Iowa. Criminal History Record attached, DCI # DCI initialsM DCI -77 (08/25/10) Received Time Jan. 4, 2019 4:09FM No.1915 Jan. 8.2019 12:05PM DCI IOWA No.8346 P. 2/9 IOWA CRIMINAL HI9TORY DCI 00370225 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 4 DATE PRINTED- DCI:00370225 2019/O1/QB-1) r-. tt NAME; BANE, THOMAS DANIEL BAME.TOH 2019 J'17 I I FIN 3: 38 DOB SEX RAC HGT WGT EYE HAIR SKN POB 19690112 M W 511 175 BRO BLK FAR IA ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 19871227 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA123-46 PUBLIC INTOX TRK#: L33479301 CHARGE NO- 02 TA STATUTE - IA719-1 INTERFERENCE WITH OFFICIAL ACTS TRK#: L33479302 CHARGE NO- 03 IA STATUTE IA723-4-1 DISORDERLY CONDUCT TRK#: L33479303 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- D1 IA STATUTE: IA123.46 CONSUMPTION / INTOXICATION - 1978 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479301 SENTENCE DISP EPF DAT PLEAD GUILTY 19871227 PINE $25 19871227 COURT COSTS $20 19871227 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA719.1(1)A INTERFERENCE W/OFFICIAL ACTS CHARGE CLASS: MISDEMEANOR CONVICTION TRO: L33479302 SENTENCE DISP EFF DAT PLEAD GUILTY 19671227 FINE $10 19671227 COURT COSTS $20 19871227 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 03 - IA STATUTE: IA723.4(1) DISORDERLY CONDUCT - FIGHTING OR VIOLENT BEHAVIOR CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L23479303 SENTENCE DISP EFF DAT PLEAD GUILTY 19871227 FINE $10 19871227 Jan. 8, 2019 12:06PM DCI IOWA COURT COSTS $20 02 ARRESTED/TAKEN INTO CUSTODY 19590507 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE XA123-46 PUBLIC INTOX TRK#: L33479401 CHARGE NO- 02 IA STATUTE IA714-2-5 THEFT SIR DEGREE TRA#: L33479402 CHARGE NO- 03 IA STATUTE IA719-1 INTERFERENCE WITH OFFICIAL ACTS TRK#: L33479403 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA123.46 CONSUMPTION / INTOXICATION - 1978 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479401 SENTENCE PLEAD GUILTY FINE $25 COURT COSTS $20 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA714.2(5) THEFT 5TH DEGREE - 1978 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479402 SENTENCE PLEAD GUILTY FINE $75 COURT COSTS $20 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE: IA719.1(1)A INTERFERENCE W/OFFICIAL ACTS CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479403 SENTENCE PLEAD GUILTY FINE $15 COURT COSTS $20 03 ARRESTED/TAKEN INTO CUSTODY 19910607 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 No.8346 P. 3/9 DCI 00370225 PAGE 2 OF 4 D 1019 JAN i I Pii 3: 3P 19871217 DISP EFF DAT 19090508 19890508 19890508 DISP EFF DAT 19890627 19890627 19590627 Jan. 8.2019 12:06PM DCI IOWA OWI TRK#: L33479501 CHARGE NO- 02 IA STATUTE IA204-401-3 POSSESS SCHEDULE I/MARIJUANA TRK#: L33479502 COURT DISPOSITION AGENCY: IAD52015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA204.401(3)(B POSSESSION OF MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479501 SENTENCE JAIL 1D CREDIT W/TIME SERVED 7H COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA321J-2 Owl CHARGE CLASS: NON CONVICTION TRK#: L33479502 SENTENCE DEFERRED JUDGEMENT DISCHARGED FROM DEFERRED JUDGEMENT 04 ARRESTED/TAKEN INTO CUSTODY 19950226 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA124-401 POSSESSION -BCH I TRK#: 014619101 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO -.01 IA STATUTE: IA124-204-4-M POSSESS MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 014619101 SUBSTANCE ABUSE EVALUATION SENTENCE SUSPENDED JAIL 30D FINE $250 COURT COSTS $75 PROBATION lY COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA665-4(2) CONTEMPT OF COURT CHARGE CLASS: MISDEMEANOR CONVICTION No.8346 P. 4/9 DCI 00370225 PAGE 3 OF 4 .FILED 2019 JAN 1 I PSH 3: 38 CI i C[_ER; DISP EFF DAT 19910826 19910826 DISP EFF DAT 19910926 19920820 DISP EFF, DAT 19950330 19950330 19950330 1995.0330 Jan. 8.2019 12:06PM DCI IOWA DCI 00370225 PAGE 4 OF 4 No.8346 P. 5/9 E!LE0 2019 All I i PHI 3: 3E . TRK#: 014619102 SENTENCE DiSP EFF DAT JAIL SO 19900915 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. 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(16). Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry: hctp://Www.iowasexoffender.com/ . However, even though some information is available on this site, 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(19). 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 i ARTS Pagel of 2 C,J10VVAD0T VVWW. Ow d L SMARTER I SIMPLER 1 CUSTOMER DRIVEN a 0 go Driver 8 W fiCalfon i�ftdoo►��i ., PO Box 9204 1 Des Mortes, IA 50306-9204 _ - - Pf101te: 515-244-9124 1 FaK 616239.1837 Inquiry 1/8/2019 Date: VAL Customer 4289265 Endorsements: None Name: Bane, Thomas Daniel Address: City/State: Mailing Address: Mailing City/State: Date of Birth: Sex: Convictions Certified Abstract of Driving Record DL/ID #: 251CCO152(IA) CDL Permit Class: None Class: D Audit #: 9689750 5038 AMERICAN LEGION Issue Date: 01/06/2016 RD SE Expiration 01/12/2021 Date: IOWA CITY, IA Endorsements: Chauffeur 3 522409070 CDL Permit Issue None Date: CDL Permit None Expiration Date: VAL CDL Permit None Endorsements: None CDL Permit None Restrictions: ELG ID Status: None 5038 AMERICAN LEGION Restrictions: Corrective Lenses DL Status: VAL RD SE Restriction None CDL Status: None IOWA CITY, IA Supplement: CDL Permit ELG 522409070 09/27/2018 Status: Seat Belt Violation 1/12/1969 Johnson CDL Cert Status: None M CDL Med Status: None History Information Citation Date Conviction Date ACD Explanation I JUR County 05/08/2016 06/13/2016 S93 Speed IA Johnson 09/11/2018 09/27/2018 F04 Seat Belt Violation IA Johnson Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date JUR Case Number 10/11/2014 IA 821287 11/07/2014 IIA ;825843 Name: Bane, Thomas Daniel DL/ID: 251CCO152 (IA) Pursuant to Iowa Code §321.10, 1, 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 pet upon this document, at Ankeny, Iowa this date: http://172.29.254.55/drivers/reports/customerhistorylcertifieddrivingrecord.aspx 1/8/2019 ARTS Name: Bane, Thomas Daniel DL/ID: 251CCO152 (IA) Page 2 of 2 1/8/2019' Driver & IdentlFlcatlon Servicdo N (2I PH 3: 38 Iowa Department of Transportation CI i Y http://172.29.254.55/drivers/repos"ts/customerhistorylcertifieddrivingrecord.aspx 1/8/2019