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Home My WebLink About15-259� r CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 3S6-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) IDENTIFICATION NO. (Office Use Only) APPLICATION FOR TAXICAB I 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 3. Contact Information (REQUIRED) Email: filmQrmeI$f (All written cooymmunnk 7J 4a. Chauffeur's License expiration date (REQUIRED) i i U b. Taxicab Business Name (REQUIRED) _ i t,I l0 -V CA 5. Prior experience in transportation of passengers: C; -hl `Ste ?q LC -.0 yl Cell Phone: 6&3Y sent via email) owo C r f - 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? e S 7 Type of offense Where When G 1`dX -370wu cli /9T6 pas5e55j6W) edule -�F JTcwa c+` I M0 at happened to the charge? (Circle one) �� r r g47 ay1 I9Y Convicted Dismissed Deferred Suspended lead Guilty Have you been arrested / charged with any traffic offenses in the last five years? Other Type of offense Where t When Spe A,17A I®MPhblpid e(' a170wxn tf C2011 ar I +o' (qbej ct rL Sq �� — p�Nq CI f� 1201 a lNr, C: �dW.4 G! gnCi1 What appened to the charge? (Circle one) « Convicted Dismissed Deferred SuspendedPlead Guil Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When (,Vrf"-Atly We S✓s(�er7c�ec� It/20115 I' . P 4L-4 b oic k r w Id S,)e Pori 9. Have yuV ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) 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). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) __. ° ':;-, 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify I_ ba issued to me by the Iowa Department of Transportation a va%Cheur's licensenumber FF; �% !� `-1 `1 issued on 9 > expiring on I understand that if I falsely answer any question in this application, that this app catio may be denied. I agree king 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 fu er agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisijp s cif Title 5, Cha r 2, o the ity Cade. (Needs to be signed in froont of a Notary Public) Signature of Applicant �� Date j0/°�3{ 15� STATE OF IOWA ) COUNTY OF JOHNSON } Subscribed and sworn to before me by `r M1 to . I� ac,)aiic Cake1 0 n this ,V 1,\ day of c� � �1 . rENDY S. MAYER Notary Public in aZl7or the State of Iowa MIT My commission Expires 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 Chauffeur's license /(tV;Z-&O Signature of e'Chief or designee 1Ch,3%jam 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. Signature of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update 1n11431j_e/S Date ciererrAxIDRNEADGEAPPL92014.endedDOC 0312015 C41UWADOT Sty ARTER I S`s�rlFLH. ICU' TOM'Eff DR04E � �tV'Vtt31i.€CiVI�C�L}�. t? ! Office, of Driver Services Po Box 142041 Des Maines. JA 5A30:^:-c+'2ff4 Phonpr 615-244-91241 WO -512-1, 121. I1 Fax. 5i5-23 -183? wWw inwado! Dow Certified Abstract of Driving Record Inquiry Date: 10/22/2015 DL/ID #: 713XX1449 (IA) CDL Permit Class: None Customer #: 1833101 Class: D CDL Permit Issue Date: None Name: Fuhrmeister, Timothy William Audit #: 7327449 CDL Permit Expiration None Linn I Date: Address: 2801 HIGHWAY 6 E LOT 245 Issue Data: 09/10/2013 CDL Permit None Endorsements: Expiration Date: 08/18/2018 COL Permit Restrictions: None City/State: IOWA CITY, IA 522402652 Endorsements: 3 ID Status: None Mailing Address; 1401 MARCY ST Restrictions: Corrective Lenses DL Status: VAL Restriction None CDL Status: None Mailing IOWA CITY, IA 522402117 Supplement: COL Permit Status: ELG City/State: Date of Birth: 8/18/1968 CDL Cert Status: None Sex: M CDL Had Status: None History Information Convictions CicaU nDate ConvictlanDate ACD E.m sailon C9un[y aftii 06/19/2011 .07/20/2011 592 Speed (10 mph & under In 35-55 mph zone) Johnson IA 08/03/2012 09/05/2012 'M14 fail to Obey Traffic Sign/Signal Johnson ',IA 09/28/2013 10/17/2013 Miscellaneous Linn I Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. >eciderrt Data Case Number JOR ]2/15/2013 ...728650. .IA _'A. 32/18/2014 ]8]W9 •gR�� Sanctions I ype fg"n"wa End ACD Explanation Gccura"va 3048 AIR Suspended 11/20/2015 'INDEFINITE D51 Non -Payment of Child Support IA IA Name: Fuhrmeister, Timothy William DL/ID: 713XX1449 Pursuant to Iowa Code ¢321.10, 1, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this is a true and accurate copy of an official record currently in the custody of said office, and that 1 have been authorized by the Director of the Iowa Department of Transportation to so certify. In witness whereof, 1 have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: c� n 1w�,.yq �t *411 VID - - T: ••• ••• �1111 `i'; 10/22/2015 IOWA y o; D. O.T.:W sC3 •gR�� Office of Driver Services iv`1I ��.,.� Iowa Department of Transportation Name: Fuhrmeisteq Timothy William DL/ID: 713XX3449 Oct, 6. 2015 8:59AM Div of Criminal Investigation No, 7829 P. 1/3 10/04/2015 06:361'el low Cab of Iowa City (FA%)3193382708 P.002/002 STATE OF IOWA Criminal History Record Check Request Form DCI Account Number; 9967-F (freppllaable) To: Iowa Division OrCrlminal Investigation eCab SuFrom: X Support Operntlons Bureau, 1"Floor P-" llow ofIowa Gita $ox 428 215 E. Ta Street Des Moines, Iowa 50319 Ipvti a City, IA. 52244 (515) 725.6066 - (SS5):7256060-Fak (319j-39$-99i`� , pbonw Vex; (319) 339.7302 T1Mol'ky vW01,01W a warver Mbrmalian: Without a signed wolves from the subjeot of the request, a complgto grlminal history record rn y not ho ralaasaDl0, per Code of Iowa, Chapter 692,2. Iror Aortipletti criminal history-reoor(1 Information, as allowed bylaw, always oblaln a waiver signature from the sub]eei of the reauatI. Waiver Release; I hereby give permlatlon for Ilia abp0e tequasang omels1 le condom on Iowa criminal hlnoryrecord cheek with the Division ofCrlminal Invtedli lion (DCO. Any erlroloal Mtlory datatoo [het Is matntalnad by I DCI may b elegised u Allowed by hw. Wai unr Sigxarurc;AVVI (DCI we only) As of Ln - _ , a search of the provided name and date of birth revealed: 0 No Iowa Criminal History Record found with DCI v- r- rrl Iowa Criminal History Record attaohed, DCI #� DCI initials_. r- tv DCI47 (09/25/10) D.._:—A 11„„ n.I 6 9l11F 6.6Fnt1 elm 0660 Oct. 1 6. 2015 9 : 0 0 A M D l v of Criminal Investigation IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI:00373688 NAME: FUHRMEISTER,TIM FUHRMBISTER, TIMOTHY WILLIAM FURHMEISTER,TIM FURHMEISTER, TIMOTHY WILLIAM DOB SEX RAC ' HOT WGT EYE 19680818 M W 600 200 BLU ADDITIONAL IDENTIFIERS TAT L ARM TAT L CALF TAT L LEG CCH RECORD *** 01 ARR88TED 19880403 DCI 00373688 PAGE Y OF 2 DATE PRINTED - 2015/10/06 HAIR 'SKI) POB BRO FAR IA AGENCY: XA0520200 IOWA CITY PA CHARGE NO- 01 IA STATUTE IA123-46 PUBLIC INTOX TRK#: L33958601 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IAJ,23.46 CONSUMPTION / INTOXICATION - 1978 CHARGE CLASS; MISDEMEANOR CONVICTION TRK#: L33958601 SENTENCE PLEAD GUILTY FINE $25 COURT COSTS $20 02 ARRESTED 19900401 AGENCY; IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA204-401-3 POSSESSION.SCHEDULE I/MARIJUANA TRK#: L13958701 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- of IA STATUTE: IA204-401-3 POSSESS SCHEDULE I/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L13958701 SENTENCE JAIL 1D CREDIT W/TIME SERVED 8H 03 ARRESTED 19971005 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA708-2A-2B ASSAULT/CAUSE INJURY/DOMESTIC TRK#; 037285101 DISP EFF DAT 19880418 19880418 19880418 DISP EVP DAT 19900703 19900703 No -7329 P. 2/3 Oct., b. 2015 9:OOAM Div of Criminal I n v e s t l g a t l o n No, 7829 P. 3/3 DCI 00373688 PAGE 2 OF 2 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA236-2-2 DOMESTIC ASSAULT CAUSING INJURY COURT CASE ID: 06521 SRCR045754 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 037285101 SENTENCE DISP EFF DAT SUSPENDED JAIL 20D 19980115 JAIL 30D 19980115 FINE $250 19900115 PROBATION 1Y 19980115 04 ARRESTED 19981104 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA706-2A(2B){3B) ASSAULT WITH INJURY/DOMESTIC/ENHANCED TRK#: 044597001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- O1 IA STATUTE: IA708-2 ASSAULT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 044597001 SENTENCE DISP EFF DAT JAIL lD 19990223 AN ARREST WITHOUT DISPOSITION IS NOT AN INDZCATICN 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. 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 ` 0 F