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Home My WebLink About15-279CITY OF IOWA CITY 410 Fast Washinglon Street Iowa city, Iowa 52290-1826 (319) 356-5040 (319) 356-5497 FAX 1, Name (RI-01JlR'[HJ) - IfJ1'AFFIFICAJ ION NO, / 5- ' ,�f (Offic' e tJee Only) APPLICATION FOR TAXICAf31 MOTORIZED PEDIGAB VEHICLE DRIVER (Police Deparirnent review must ho mado bctweon ft a.m. to 3 p.rn., Monday —Friday) l;uluRi^luecdr.Ih4�ia.k'�t,`r�.,(nrrr:e�'etn�uai�+r�+rrvr7latrlllnlrl�F�+t(} ur,�,i�.yq� ��literrr First Last 2. Address (f•.l{JlJll'if_C)) _22-C -- 5� Ne C'1 ba 3. Contact Information (dl C1,lJII�F U) Email �r ��L y_n a�� r .�_ _Gell Phone: 3 i�h?"5 ',�J_j. (All Mritten CommuniGMion sent via email) 4a. Chauffeur's License expiration date (ftt`:011112fa:1) 1). Taxicab Business Name Hf:.0I I.[)) Prior experience in transportation of passengers: 'Z 6. Have you ever been arrester) /charged with any misdemeanors andloi felonies in this State or elsewhere? Y&.- Type of offense Where When Z14 415r I �- 0 114 1�y-.r What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended E, Plead Guilt;) Other 7. I -lave you been arrested I charged with any traffic offenses in the last five years? Type of offense spe�Ain� WhPf I d t th h v Circle one Where When C'.Iy fa Ya-)Iz -Ya6nxN (''fy a iap ene o cc arge, ( ) ----.--_,1 Convicted Dismissed Deferred Suspended CP.Lead Guil/ Other 6. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /x - Type of offense Where When 9. Have you ever applied to bean 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 I -OR REQUIRED SIGNATURE AND NOTARY) 0212015 APPLICA710N 1-''0R'fAXIC Ai,' VEHICLE DRIVER Page 2. I hereby certify that I have issued to me by the Iowa De artment of Transportation a valid Chauffeur's license number issued on ! �;J__ expiring on _ A --__. _„ . I understand that if I falsely answer any questions in this application, that this a plication 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- *#wa STATE OF IOVVA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by�.�,jr _ _ tia,r _ _ _ on this. day of -t., Public in Qid for the State *FRGkkkR*kk AkkAkk Ak Rkkk*k XR***kkkkk*k*Fkkk R*kkk*kk*kk*k#kFkkkRk Ak**Nkk GkAkNAA kA**k*kkkkk*kkGk*kG NGNNG*kkN#kXkkhkk*kN kkk FN£NA kkkkkk kk+k£k£k#kAk*N I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- rnined that there is no information which would indicate that the issuance would he detrimental to the safety, health or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). d)� Signaty e f Poli CI of 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. THE EFFECTIVE DATE WILL MATCH THE CHAUFFEUR'S LICENSE EXPIRATION IF LESS THAN A YEAR. SignAture of City Clerk or designee - L-. 5 Date *#*#A£*kAA},kk}£AkA*k*kk*R*k**}iAIA*£Rr'A*k£G*k*Ak££*kkkk**k4****R*k£3*k**kkkk Akxk***k#£*kAk*£xAR*RA*£kx**#k3A*k:kAxF*A Office, Use Only Approved application DCl report State certified driving record Website update cp,wraxioarvenocenaa�6zo,aak�k�aed.Doc 0212015 .. DOT wwwIdwad6t. g0v, SMARTER I SIMPLER I CUSTOMER DRIVEN pffice of Driver Services PO Box 92011 Des Moines, [R 593969264 Phone: 515-244-9124 1899-532-f 1211 Pak: 515-239-1837 warv.lowad6i Certified Abstreot of Driving Record Inquiry Dat., 2/25/2015 DL/ID p: 5E6ZZ96)2 HA) Customer Sr 2092967 Name: Smith, Timothy Paul class, D to Status, None Address: 220 S CHESTNUT 5T APT 2 Audit it 6615605 OLstatus: VAL 09!20/:U33 ;10/29/ZOIJM Issue Data. 01/15/2613 CDL Status: None city/state: NORIH LIBERIY, Is 523179111 Expiration Date: 01/13/2018 COL Cert Status: None Endorsements: 3 COL Med Status: None Mailing Addressr 220 S CHESTNUT ST APT 2 ResMctloin Corrective Lenses Rastrictian Nan, Date of aldla 1/13/1975 Supplamcatr Mailing City/State: NORTH LIBERTY, IA 523/79111 Sex: M History Information convictions citation Date ca.A ion Data ACD Explanation County SUR '�W� 592 jSpeea _.. _- _.. -. ]ohmson -1A _..-.. 07(13/2613 109/10/2013 X592 � -Peed p&undo0 mph &.under In 35 55 mphhz zone) ]ahnson to 09!20/:U33 ;10/29/ZOIJM 34 g6all lu Obey Traffic si n/SI nal m, 9 9.. .....,:..._ ]ahnson ..,..,,.., ....... _-IA ........:......, ... 09/20121114 .. ',10/36/2019 ;S92 j511ced ]ahnhmson :IA Name: S,mlh, Timothy Paul DL/ID: 556ZZ4072 Pursuant to Iowa Code 9321.10, 1, Kim Smoak, Dhecter of Office of Driver SeMces, Iowa Department of Transportation, do hereby certify that I am the custodlon of the records held by the ON. of Driver Services, that this Is a true and accurate copy of an official record currently In the custody of sell office, and that I have been authedzed by the Dltec or aline Iowa Department of Tromportatlon to so certify. In witness whereof, I have caused my signature and the seal of the Oepadment to I)Q set upon this document, at Ankeny, Iowa this date: oe�icif oi`hl 0 • • • �A'9, 2/25/2015 If ;fit: Q. 0. L •�� '�W� 4,6p ♦ 1' hhI iYtR-�" Office of DriverSerwoes ra, Iorrs Department Transportation Name: Snit h, T3 me thy Paul DL(10: 556ZZ X72 State of Iowa Renuestinv an Tnwn criminal hiatory record check on: Fill in all shaded areas. Last Name Apellfdo (mandatory) First Primer Nombre (mandatory) Middle Name Segundo Nombre (recotmnended) Name Date of Fccha Nncimfenro (mandatory) Gender Gene) o (mandatary) Social Security Number (recommended) �Birth +Male ❑ Female y 8 s 9r, 37gr Waiver Signature Firma (If the request is on yourself, please sign. Kam request is ua suweone else, write N/A.) Results D IIISF.OYLY As of 1 Z Z L�- , a name and date of birth check revealed: ❑ No record found 0 Record attached DCI #) Ci3cj DC[ initials Receipt Number of requests i Method of payment: Cardholder's name DC-- initials Credit Card # x $15.00 per last name = Total amount $ 15. O o cash money order I D 8 & check # DCI -83 (09/09/10; Reviscd 10/1/10; form reviewed 08/11/14) Exp. Date MasterCard or Visa (Last d digits) ADDITIONAL SDEN'1'IFIERS SC ABDOM SC BREAST CCH RECORD *** 01 ARRESTED 19970124 IOWA CRIMINAL HISTORY DCI 00543519 CHARGE NO- 01 IA STATUTE IA714-2-2 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 COURT DISPOSITION DATE PRINTED - COUNT NO- Ol IA STATUTE: IA714-2(5) THEFT 5TH DEGREE 2015/02/24 DCi:00543519 TRK#: 015588501 SENTENCE NAME: SMITH, TIM FINE $65 19970506 COURT COSTS 19970506 SMITH, TIMOTHY PAUL MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IUENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE DOB SEX RAC HGT WGT EYE HAIR SKN POR 197501.13 ti W 602 200 BRO BRO MED IA ADDITIONAL SDEN'1'IFIERS SC ABDOM SC BREAST CCH RECORD *** 01 ARRESTED 19970124 AGENCY: IA0180100 CHEROKEE PD CHARGE NO- 01 IA STATUTE IA714-2-2 THEFT 2ND DEGREE TRK#; 015580501 COURT DISPOSITION AGENCY: IA018015,7 CHEROKEE CO DIST COURT COUNT NO- Ol IA STATUTE: IA714-2(5) THEFT 5TH DEGREE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 015588501 SENTENCE DISP EFF DAT FINE $65 19970506 COURT COSTS 19970506 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IUENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAP] ENFORCE148NT AGENCIES BY THE UCI. 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(