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Home My WebLink About16-043r m Olt 15q._p CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52 240-1 82 6 (3 191 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) . IDENTIFICATION NO. /1-0 0 y (Office Use On y 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 First Last 2. Address (REQUIRED) 22 o S Chrsln S F ! 'Nz Ah r! -d. L bt 119 /f7 5 Zai 7 3, Contact Information (REQUIRED) Email: Cell Phone: 3i) 3z,, s �3 (All written communica fon sent via email) 4a. Chauffeur's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) _ 5. Prior experience in transportation of passengers: _ r- 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? yes Tyne of offense 2 k�t` D""" Where When Aw 5 �kyna� What happened to the charge? (Circle one) A Convicted Dismissed Deferred Suspended (PLlead Other ft. Have you been arrested / charged with any traffic offenses in the last five years? y s Tvpe of offense Where When /d �1J 2u2 S�J�fdn6 rd >< /v9 J-1 Z S What happened to the charge? (Circle one) Convicted Dismissed Deferred SuspendedPeal d Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Nc Type 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)— N DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIR- DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF RE - P 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 that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 55G ;?Zvovz issued on 3 expiring oni/j3/2p Fs . I understand that if I falsely answer any questions in this application, that this application may be denied. I agfee 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 Z z[; STATE OF IOWA ) COUNTYOFJOHNSON ) Subseribpd and sworn to before me by I etc 1— <�Yv L� on this �� 1 day of / /I i...^< KELLIE K. TUTTLE ` C. (r�- s omn,issfon rmmber221a1 tary Public in and for the State of Iowa f y o mi I�ow c - 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 a8/2::�>)� Signature o C iief 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. e d Signature of City Clerk or designee Approved application DCI report State certified driving record Website update 3� Date 11 Y Office Use Only Cle`k7AXInRIV6ADGEA.PPL92014an,ended.00c 03!2015 Ftep. Id. IUIO, il,'LbHl41 Viv o Criminal InvestigationRio, 1908 P. 1/5 aa06 P.002/o Os STATER OF IOWA Crfilllinal History Record Check Request. Form To: Tovja Division of Criminal ,IV estigatinI, Support Operations Burcau, 1" Flour 215 E. 7i1' Street Des Jl►eilles, Iowa 50319 (515) 725-6066 (S15) 725-6080 Fax am requesting an lova C�\ DCl Account Number: L. —._J Dj�z =j= (if applicable) From! CG�oTlowa City Chy Clark's 0mcc0mce 910 E. Washington ..tree( _Iowa Cil 52240 Phone: 319-356-5041 Fax; 319-356-5497 m I a^ M. 4-A (JJ Date of Birth paandamn) Gender ry) .S2631 Secnri INuMber (mton,mendeE (mandato I �3/ �' ®R1ale ❑Female 2/$-- 96 3733- WnlPer n Orn7Ati0h, Without a signed waiver from the subject of the request, a complcle criminal history record may not be releasable, per Code of Jawa, Chapter 692.2. For complete criminat his(ory record obGnfol'mation, as allowed by law, always tain a waiversG nature Trom the subject of the renuest. Wnlyer itelertse: I hereby give pennitsloil for Ibe above mquezline official to eondou m Iowa criminal history record check whh Um Division of lsindna! Igvcsligstlan (DCI). My erimiaal hinDry dale concerning me lhet is maimaiaed by (lit Del may be reltssed is ellwved by lily 1yniver.Signature: loai'a Criminal History Record Check Results �— (pCl use only) As of a �`� i° a search of the provided name and date of birth revealed; —11 No Iowa Diatinal History Itecold found with DCI 1 17 attac Iowa Criminal History Record hed, DCI if S j 5j i ' DCC initials. cin DCI, 77 (06/25/10) --- Received Time Feb. 16, 2016 HAM No. 7461 e I11:29AM Div o+ Criminal Investigation No, /908 P. 2/§ IOWA CRIMINAL HISTORY DCI 00543519 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- 2016/02/18 DCI:00543519 NAME: SMITH,TIM SMITH,TIMOTHY PAUL DOB SEX RAC HGT WOT EYE HAIR SXN POB 19750113 M W 602 200 SRO BRO MED IA ADDITIONAL IDENTIFIERS SC ABDOM SC BREAST CCH RECORD +'++ 01 ARRESTRD 19970139 AGENCY; TA0180100 CHEROKEE PD CHARGE NO- 01 IA STATUTE IA714-2-2 THEFT 2ND DEGREE TRK#: 015568501 COURT DISPOSITION AGENCY: IA018015J CHEROKEE CO DIST COURT COUNT NO- 01 IA STATUTE: IA714-2(5) THEFT STH DEGREE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#; 015506501 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 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 c, ., � rO Iowa Department of Transportation Co U:fice o1 F KVK 3erwes { iol£ 1 me) OW 512,1121 P13 go, 9204, Lies Mones,1A 50306 9204 515144 9124 �Aac: 519 239 111 NW History Information Convictions Citation Date Certified Abstract of Driving Record ACD Inquiry Date: 2/16/2016 DL/ID #: 556ZZ4072 (IA) Customer #: 2042987 Name: Smith, Timothy Paul Class: D ID Status: None Address: 220 S CHESTNUT Audit #: 6615605 DL Status: VAL Pail to Obey Traffic Sign/Signal ST APT 2 IA 09/20/2014 10/3012014 IS92 Speed Johnson Issue Date: 01/15/2013 CDL Status: None City/State: NORTH LIBERTY, IA Expiration Date: 01/13/2018 CDL Cert Status: None 523179111 Endorsements: 3 CDL Med Status: None Mailing Address: 220 S CHESTNUT Restrictions: Corrective Lenses Restriction None ST APT 2 Supplement: Date of Birth: 1/13/1975 Mailing NORTH LIBERTY, IA Sex: M City/State: 523179111 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 10/12/2012 11/13/2012 S92 Seed Johnson IA 07/13/2013 09/10/2013 S92 Speed (10 mph & under in 35-55 mph zone Johnson IA 09/20/2013 10/29/2913 M14 Pail to Obey Traffic Sign/Signal Johnson IA 09/20/2014 10/3012014 IS92 Speed Johnson IA Name: Smith, Timothy Paul DL/ID: 556ZZ4072 Pursuant to Iowa Code §321.10, I, 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 11 an official record currently in the custody of said Office, and that I have been authorized by the Director of tielowa Department of Transportation to so certify. - t In witness whereof, I have caused my signature and the seal of the Department to be set upon tlfis ;documeW,, at Arfkeny, Iowa this date: ; 2/16/2016 Name: Smith, Timothy Paul DL/ID: 556ZZ4072 Office of Driver Services Iowa Department of Transporation :v r _F i rd� ;V Z _ ,ry