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Home My WebLink About21-004� t CITY OF IOWA CITY 410 East Washington Street lona City. 101.8 52240-1826 13191356.5040 13191 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. (3 LA (Office Use Only) JAN 2 0 2021 APPLICA-nO,N FO TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Deptlt'Ctrldrk4eoId1w`*1jst 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 First Middle 3. Contact Information (REQUIRED) Email: 111n fr 1Z y'q /0G Cell Phone: �30-730- q yZS (Ab written commu ication sent via email) 4a. Driver's License expiration date (REQUIRED) _ b. Taxicab Business Name (REQUIRED) _ 5. Prior experience in transportation of passengers: L" -Cue LtIiP Tl/ lf6 M 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When t nAer nuc D a 14 IOU, l �i�,�rie,-tom cnn�I.u�t- t r�- IQR7 yt�Cj 196`3 in3er.�<�enlc ur� o�;c;c t n �� ! r? 14Rq What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended sad Gu Other 7. Have you been arrested / charged with any traffic offenses in the last five years? �>° 5 Tvve of offense W here When What happened to the charge? (Circle one) Conv1lteDismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /t/0 Type of offense Where When 9. Have you eves applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) 0412018 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 hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number 2 S ) G CL G I �-2 issued on1241 J� expiring on l //-z/z l . 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, 1 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 Applicants Date L Fff *YYifRR}1ff ARYf##YHRM#HY#YfYYYY#ffNf ff Yflff fRY4}ff##Y#i#Y#fHRiffIRR#fR1fiN}H,YYR#R}HNfIM#}NfH1MHYh,F###4ffffYY#}f#f!f}kflf f #RYt#[ STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by on this day of Notary Public in and for the State of Iowa *******R*******R*k**f*k*}***R*#M********k**}********1M*******1**..***F**iM*A**+#**i***##******* 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 Driver's license Signature of or designee Z) 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. Office Use Only Approved application DCI report State certified driving record Website update Date ClerWAXIDRNBADGEAPP1,920181mend,00C 04/2018 STATE OF IOWA Criminal History Record Check Request )Form Mail or Fax cmPlMed forms to; Iowa Division of Criminal Investigation Support Operations Bureau, 14 Fbor 215 M 76 Street Des Moines, Iowa 50319 , (515) 725-6066 (515)725.6080 Fax 8;4N �7 1 am repuestwp an lows Criminal Histoiy Record Check on: DCI AccountNumber: 9967-F (ifaypiieebk) Sand results tp! Name YeliOw,Cab of Iowa City Address P.O. Boz 428 Iowa City, Iowa 121" T P►oao (319)339-9777 _ V Fax 319-359-4142 9 C".tf��'�'�`T' 1 '/,'-.1 �.1 �2'}`��C'1 �'iiL(�yT/'11�1'A�f'yYi!�n�t•I7%�:: ' �'��'�'��y�%'�l.r•�ti+;.-F�4.4j4%I��„�a�vya.'ym �.SL=2�<�.•.��'LSlil��"2.�a�'��S]eT'�ir�. afy�y. .vim/ w u�. Ci .i�.(.' 'PS.��.1 4 L �Olw�1i1 I�r�11 r f80e,y) J As of a search of tho provided name an 'of birth reveaW: -n n Owl i.1E:Fr rri .,�tv LT �t a i v r •"�� • C-5 e r 1 e L f� .�.' n ..i II t1 1 • 7 L f i Tt f .C..),.d. J ..t.. co co ncT 77 (updated o6,2&7oi8) Page 1 oft Received Time Dec. 31. 2020 2:07PM No. 8901 Iowa Criminal History RecordChecc )r results. _ F ults,• �Q f80e,y) As of a search of tho provided name an 'of birth reveaW: -n n a rri ❑ No Iowa Criminal History Record found with DCI 0j'1Q! ion Ilso`gO `\ z w o Iowa Criminal histo Record attached,DCT #_31Q),23m ry.__ D N o � o co co DCI initials — ncT 77 (updated o6,2&7oi8) Page 1 oft Received Time Dec. 31. 2020 2:07PM No. 8901 DISORDERLY CONDUCT - FIGHTING OR VIOLENT BEHAVIOR CHARGE CLASS; MISDEMEANOR CONVICTION TRK#: L33479303 SENTENCE DISP EFF DAT PLEAD GUILTY 19671227 FINE $10 19871227 IOWA CRIMINAL HISTORY DCI 00370225 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 4 DATE PRINTED - 2021/01/04 13CI:00370225 NAME: DANE, THOMAS DANIEL BANE,TOM DOB SEX RAC HGT WGT EYE HAIR SKN POB 19690112 M W 511 175 BRO ELK 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 INTOE TRK#: L33479301 CHARGE NO- 02 IA STATUTE IA719-1 INTERFERENCE WITH OFFICIAL ACTS TRK#: L33479302 CHARGE NO- 03 IA STATUTE IA723-4-1 DI80RDERLY CONDUCT TRK#: L33479303 COURT D13FOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA123.46 CONSUMPTION / INTOXICATION - 197B CHARGE CLASS: MISDEMEANOR CONVICTION TRIC#: L33479301 SENTENCE DISP EFF DAT PLEAD GUILTY 19871227 FINE $25 19871227 COURT COSTS $20 19871227 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA719.1(1)A INTERFERMACR W/OFFICIAL ACTS CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479302 SENTENCE DISP EFF DAT PLEAD GUILTY 19871227 FINE $10 19871227 COURT COSTS $20 19871227 COURT DISPOSITION AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO- D3 IA STATUTE; IA723.4(1) DISORDERLY CONDUCT - FIGHTING OR VIOLENT BEHAVIOR CHARGE CLASS; MISDEMEANOR CONVICTION TRK#: L33479303 SENTENCE DISP EFF DAT PLEAD GUILTY 19671227 FINE $10 19871227 COURT COSTS $20 02 ARRESTED/TAKEN INTO CUSTODY 19890507 AGENCY: IAD520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA123-46 PUBLIC INTO$ TRK#: L33479401 CHARGE NO- 02 IA STATUTE XA'114-2-5 THEFT STH DEGREE TRK#: 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 CONOUM]PITON / INTOXICATION - 1978 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33479401 SENTENCE PLEAD GUILTY FINE $25 COURT COSTS $20 COURT DISPOSITION AGENCY: XA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA714.2(5) THEFT STB DEGREE - 1978 CHARGE CLASS: MISDRMEANOR CONVICTION TRK#: L33479402 SENTENCE PLEAD GUILTY FINE $75 COURT COSTS $20 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE: YA719.1(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: 1AD520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 DCI 00370225 PAGE 2 OF 4 19811227 nISP EFF DAT 19890508 19890508 19090500 DISP EFF DAT 19090627 19890627 19890627 OWI TRK#; L33479501 CHARGE NO- 02 IA STATUTE IA204-401-3 POSSESS SCHEDULE I/MARIJUANA TRK#: L33479502 COURT DISPOSITION AGENCY: IA052015J 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 ONI CHARGE CLASS: NON CONVICTION IRK#: L33179502 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-SCH 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 301) FINE $250 COURT COSTS $75 PROBATION 1Y COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA665-4(2) CONTEMPT OF COURT CHARGE CLASS- MISDEMEANOR CONVICTION DCI 00370225 PAGE 3 OF 4 DISP EFF DAT 19910826 19910026 DISP EFF DAT 19910926 19920820 DISP EFF LAT 19950330 19950330 19950330 19950330 TRK#: 014619102 SENTENCE JAIL 5D DCT 00370225 PACE 4 OF 4 DISP BPF DAT 19980915 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(18). Additionally, criminal history data concerning conviction& 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 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 QJ10WADOT 251CCO152(IA) �—� *-ti%w-iouvadot.gov SMARTER I SIMPLER f CUSTOMER DRIVER 9689750 Issue Date: Driver a Idwifisation SMiess Expiration Date: PO Box 92041 Des MAcines IA 533 6-M Endorsements: Phone 5 15-744-9124 1 Fat '.15-210-I897 Inquiry Date: Name: Address: City/State: Certified Abstract of Driving Record 1/4/2021 Bane, Thomas Daniel 5038 AMERICAN LEGION RD SE IOWA CITY, IA 522409070 Mailing Address: 5038 AMERICAN LEGION RD SE Mailing City/State: Convictions IOWA CITY, IA 522409070 DL/ID #: 251CCO152(IA) Class: D Audit #: 9689750 Issue Date: 01/06/2016 Expiration Date: 01/12/2021 Endorsements: Chauffeur 3 Restrictions: Corrective Lenses Date of Birth: 01/12/1969 Sex: M History Information Customer #: 4289265 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Cam Number 3UR 101/31/2019 1095166 IA Name: Bane, Thomas Daniel DL/ID: 251CCO152 pursuant to Iowa Code §321.10, I, Darcy Doty, Director of Driver & Identification Services, Iowa Department of Transportation, do hereby certify that 1 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: Qpp, )E Ni OP pk 49SC 1/4/2021 Driver & Identification Services Iowa Department of Transporation Name: Bane, Thomas Daniel DL/ID: 251CCO152