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Home My WebLink About20-005CITY OF IOWA CITY 410 East Washington Strecl Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) _ IDENTIFICATION NO. _ 652lp-T7r (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 Last 3. Contact Information (REQUIRED) Email: (All written 4a. Drivers License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) _ 5. Prior experience in transportation of passengers: G Pr -nue n hVP First Middle I A+7h X� R U L" Cell Phone: cation sent via email) 12/2621 r anA, rEDoab(i If\ 4-P 11.e h; c ho -Fo✓ b V -P a r S 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Tvce of offense Where When P�� y ll� IC I 'Ch-io lu T hL �D s l2/2 / S/he-�-e t-rtrCn ct(1' w P h o �-!t7 i� e�l ��r h n so.�T ��` /%//�� (Cmvr�,W, [ 7� `� Y, -S -?P 11 c� fjl r 107/ l C, rt.Q 4 0/261/ 5 - What happened to the charge? ne) onvlcte\d Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arres reed With any traffic offenses in the last five years? ye S Type of offense Where When 25 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? /JO 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) 04/2018 G Page 2 APPLICATION FOR TAXICAB VEHICLE DRIVER 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 hereb certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number Z S C( O 1 SZ_ issued on expiring on 1//Z/ Z I . 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 111312 O STATE OF IOWA ) COUNTY OF JOHNSON ) _Subscribed and sworn to before me by Tt c;,-_0, on this /A day of a tires !.a 7� TiC>. 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). ExpiratioXdate f Dri -(cense 01-!Z—UZ1 Signa 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 /- /4 -_Zan Date CIBIk?A%IDRIVB.ADGEAPPL9201 Semended.DOC 04/2018 Jan. 9.2020 1:48PM DCI IOWA No.4901 P. 5/9 Prom:Clty of to Wm City CiO k Of los 379 3666La7 ol/03/2020 77:20 0737 P.002/002 STATE OF IOWA Criminal History Recoid Check Request Form" To: Tows Division of Criminal investigation Support operotionsBu eau, III Floor 215 L 7a Street Des Moines, Iowa 40319 (515)725-6066 (515) 725-6080 Fax 1 am requestag an lows Criminal History Record Clteck on: DCIAccmmtNumbor: MOL— (ifapPliOW) From: _py glows city City Clerkle 011lce 410 k Washington Street Iowa City, LA 52240 Phone. 319.356-S041 Fax. 319-356-5497 Last Name (matdiconj Fist Name (menddo Middle Name (ncontolenaea �ai\e, �� Pf�1gS Pon j"P1 Date of Birt4 (mmado Gender (mandato S�121Securi Namher(reeommio,w) / Male (=1Female pl S` 9 �— L Q $'e� Wi a ver Ltfatrrtalron: Without a signed waiver from the subject of the tcquest, a complete criminaI history record be rehiisnbla, per Code of Iowa, Chapter 692,2• Fore lete criminal history record inforluatlon, may no( AN allowed re a ehvgyr obtain a Waiver slenature from the subject of the reanpne_ Wirtyrlr RE191 at:: I hembygive perminlen for the above requcltingo6ldd to wndaetae Iowa ceiminal bktoiyreeord ehet$wllh dxDivitien ercrimm 1nvedi9d00n(DC9, Anyeliminali4naryd.tomnecrWngmedl.eismainlaioedby111eDClmaybereliuedasdlmvedbyha, As of LEI WaiPerSfgnalsore. C( ao-�.a a search of the provided aamc and data of birth 1'0e91ed: No Iow ,G:�! FIMINAL•IN a Critninal History Record found with DCI : ' d• Iowa Criminal History Record attached, DCI # ) DCI initials kE— DCI-77 (08/25/10) Onrnio>A Time .Inn I 9070. A•1APM Nn VAR Jan, 9, 2020 1:48PM DCI IOWA No, 4901 P. 6/9 IOWA CRIMINAL HISTORY DCI 00370225 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 4 DATE PRINTED - 2020/01/09 DCI:00370225 NAME: DANE,THOMAS DANIEL BANE, TOM D013 SEX RAC HGT WGT EYE HAIR SKN POE 19690112 M W 511 175 ERO ELK FAR IA ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 19071227 AGENCY: 1AUS20200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA123-46 TRK#: L33479301 CHARGE NO- 02 IA STATUTE IA719-1 7iS�AfNCimNS6'Rc.�O$�.r.nr.AL RCTS TRK$: L33479302 CHARGE NO- 03 IA STATUTE IA723-4-1 aaS!$EDLFalf 'BONDUCT TRK#: L33479303 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA123.46 CONSUMP43O 9LZIMOxXICATION - 1970 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479301 SENTENCE DISP EFF DAT �U.ILIY— 19871227 FINE $25 19871227 COURT COSTS $20 19071227 COURT DISPOSITION AGENCY: IAD520159 JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA719.1(1)A �p$aRFERENGP?.LY/DYR2oFAv^•AGTs CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479302 SENTENCE DISP EEE DAT p EAD ,GUILTY 19871227 FINE $10 19871227 COURT COSTS $20 19871227 COURT DISPOSITION AGENCY: IA053015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE: IA723.4(1) ��30RDERT„v COND$,,I - FIGHTING OR VIOLENT BEHAVIOR CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479303 SENTENCE DISP EFF DAT AWEEAD'GtIL Y' 19871227 FINE $10 19871227 Jan. 9.2020 1:49PM DCI IOWA COURT COSTS $20 02 ARRESTED/TAKEN INTO CUSTODY 19890507 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA123-46 4umLwc-lN493R TRK#: L33479401 CHARGE NO- 02 IA STATUTE IA714-2-5 TRK#: L33479402 CHARGE NO- 03 IA STATUTE IA719-1 r�maa;FaR�oF:�,xalAL-uxs- TRK#: D33479403 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA123.46 �n*�'QTTMp'R*Oit�/e=3D1TDR€C°M7°ION - 1978 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479401 SENTENCE PztHAD-G lwy-- FINE $25 COURT COSTS $20 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA714,2(5) `970 CHARGE CLASS: MISDEMEANOR CONVICTION TER#: L33479402 SENTENCE FINE $75 COURT COSTS $20 COURT DISPOSITION AGENCY: TA052015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE: IA719.1(1)A y��yysvcon��OIT`1`iJ�l'1'�'C"Tb CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479403 SENTENCE Pte` FINE $15 COURT COSTS $20 03 ARRESTED/TAKEN INTO CUSTODY 19910607 AGENCY; IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 DCI 00370225 PAGE 2 OF 4 19871227 DISP EFF DAT 19890506 19B90508 19890508 DISP EFF DAT 19690627 19890627 19890627 No.4901 P, 7/9 i &L%"moa.wauawsasIW : smo asuv iO a�sssog=se�,aawaanae� (Z) 4-999YI :Rxuvss VI ZO -09 Moo IHAaa SSIa 00 NOSNHOr r5TO45owl :XDNZE)V Noxsxsoasxa Sino OEE0966T AT NOIIVEO'dd OEV0566T SLS' SZ300 IHa00 OCE0966T 050 HNI3 OEED966T CID 'IIHr asaNsasns zea aaa dSTa HONHINHS NOIIVflgVAH sSaflY HDKVLSsAS TOT619VTO o#XHI rTOSa�zANoaateNeHwaasxw �ss�To aDH�Ho -.' v�rArxH�.ccttseaa w-4-4oz-4ztvl=HInIVILS e2 To -ON INnoo LHn00 zSIa 00 Nosmor r91oz9ovi :EONSDK NOTIISOdSIa LHA00 TOTST94T0 :#XHI T04-4zTVx sSaLYSs vi TO -ON wmuo ad H'IRIA'mo0 OOTOZSO@I :Xoxsov 9ZZOS66T ][aOLSti3 OXXT NHHYL/asLSHHHV 40 immoaar as macs MUM wou aHDHHHosia 9ZG01661 "LT:3wsoffiff''�a2iIiI Ida ads aSIa 90119=98 Z056L4EEZ �#XHL �NQT-I'JTANo3°SNOR SSY',SO sDHHHO -, Z-rTZEVI :szoLKzs HI zo -ON INn00 luno zSIa 00 NOSNHOr r5TOZSOKI !AONHDV NOTLT90asia xuaoo 9ZOOT661 HL aHAMS VIVA XIasHO 9ZOOT661 (IT RIKr LHa aaa asla HONHSNHs TOS6L5EER '#X-dL -mimmanw ,aomwaam :ssrio souvoo @N 1i"`3'0'vK038Hltbm :8) (E)T04'402YI tszam's VI TO -ON zNA00 IHAOO LSIa 00 NOsNHOC rslozsOKI °.T.7NHDK NOxllsoasIa LHAoo Z056L4EE4 :#XHI £-TO4-toM HIAZYzs ex ZO -ON ZEAIVHO T096L8EE'I '#xHz _;kUbb 4 d0 E HEM SZZOLE00 I0a 6/8 'd 1066 'ON Vol 100 WdW l OZOZ '6 '°Ef Jan. 9.2020 1:50PM DCI IOWA DCI 00370225 PAGE 4 OF 4 TRK#: 014619102 SENTENCE DISP EFF DAT JAIL 5D 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 DCT. N0.4901 P. 9/9 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(39). 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 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 Cede section 232.147(18). IN THE AS$ENCE 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 CRIMI14AL INVESTIGATION C410WADOT www.iowadot.gov SMARTER I SIMPLER I CUSTOMER DRIVEN Dnver 8 IdentifiC9fl8n Servim PO Box 92631 DesMoirm. IA 5=15.9263 pWe: 5152449124 ( Fax. 515-239 1537 Inquiry 1/8/2020 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 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 01/31/2019 IA 1095166 Name: Bane, Thomas Daniel DL/ID: 251CCO152 (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: