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Home My WebLink About17-039� r 1 J= -4 i �III� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 5 2240-1 82 6 13 191 356-5040 (319) 356-5497 FAX IDENTIFICATION NO. I !—D :Jq (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 First 1. Name (REQUIRED)/ Imc Last 2. Address (REQUIRED) '220 S L ne s}n } S+ +t z N L., � J , , /A 3. Contact Information (REQUIRED) Email: bcoA4re¢fzoow Cell Phone: 319.37.E-3873 (All written communicate n.�+oo.csent via email) 4a. Driver's License expiration date (REQUIRED) 5 s6 2,R7 Yo "72 b. Taxicab Business Name (REQUIRED) MA rce's %r; 5. Prior experience in transportation of passengers: StiJ (15. 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 2 'at n ce il., �f ei4r s IcEc 4 0 1,917 '7 � v Ay eN., V Sew Cy, fh 14 l 9 9 What happened to the charge? (Circle one) Z ^ A 4-5. S./ewn Convicted Dismissed Deferred Suspended lead Guil Other 4. s� fj Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where When Spe CG('nA b�,,Sn 6,A4v, A2 �i i 07/ / 0914111, /.A og/zo/is What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Ate) 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) 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) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number Ss62R IVO 72 issued on l ,_,rzfj expiring on I understand that if I falsely answer any questions in this application, that this a Iic tion may be denied. I a ee 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 _ /, ,d Date 1S1 STATE OF IOWA ) COUNTY OF JOHNSON ) ubscribgd and sworn to before me by % ` A spd, AZ�4, on this �_ day of r_= --r NIENDY S. MAYER _-- in and for the StAte of Iowa 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 t)i � Iowa City (Title 5, Chapter 2, City Code). license (I is I I i Dab of Police Chief or designee 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. SSliignature of City CI r F or designee J Office Use Only Approved application DCI report State certified driving record Website update Date Ge*/TMIDRN94DGEAPPL=14e.e d E.DDC 07/2016 AC Iowa Department of Transportation Office of Uftver ServlsA-- (Io l Ffce) 800 53'2-1121 PO SW 92D4, EX-,% MaincS, IA 503116 9204 515-244--4124 FAX: 513234 1831 Certified Abstract of Driving Record Inquiry Date: 3/8/2017 DL/ID #: 556ZZ4072 (IA) Customer #: 2042987 Name: Smith, Timothy Paul Class: D ID Status: None Address: 220 S CHESTNUT Audit #: 6615605 DL Status: VAL 09/20/2013 ST APT 2 M14 Fall to Obey Traffic Si n Si nal Johnson IA 109/2012014 110/30/2014 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 Mallin g NORTH LIBERTY, IA Sex: M City/state: 523179111 History Information Convictions Citation Date Conviction Date ACD Explanation County 7UR 10 1 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 10/29/2013 M14 Fall to Obey Traffic Si n Si nal Johnson IA 109/2012014 110/30/2014 S92 Seed Johnson IA Name: Smith, Timothy Paul DL/ID: 556ZZ4072 Pursuant to Iowa Code 4321.10, I, Melissa Spiegel, 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 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: r,� " AMEIN 3/8/2017 IOWA Q. 0. T. Office of Driver Services Iowa Department of Transporation Name: Smith, Timothy Paul DL/ID: 556ZZ4072 State of Iowa Division of Criminal Investigation 215 E. 7'h Street Des Moines, Iowa 50319 Phone: 515/725-6066 Fax: 515/725-6080 Iowa Criminal History Record Check Walk -In Request Your name: e { P ,,� Address: 220 s 4kYf,.f S+ -"-Z Ci /State/Zi G / Phone #: . 3 z . 3 -7 Requesting an Iowa criminal history record check on: Fill in all shaded areas. Last Name .ipellido (mandatory) First Name Primer Nombre (mandatory) Middle Name Segundo Nombre (recommended) SM ! �'1'1 1 t MaiR+f �Av Date of Birth Fecha Nacimiento (mandatory) Gender Genera (mandatory) Social Security Number (recommended) S Z/ ® Male ❑ Female 3735W114 9,s-- 9& .3-23-5-- Waiver aiver SI aturee FFiim Qf the request is on yourself, please sign. If the request is on someone else, write N/A) —/z OUSE ON Y Results I As of 3) �` { a name and date of birth check revealed: ❑ No record found Co *ecord attached DCI # - r DCI initials Receipt Number of requests t x $15.00 per last name = Total amount $ Method of payment: cash money order ( l 8 $ check # MasterCard or Visa (Last 4 digits) Cardholder's name 3 DCI initials - ------------- Credit Card # Exp. Date DCI -83 (09/09/10; Revised 10/1/10; form reviewed 08/11/14) IOWA CRIMINAL HISTORY DCI 00543519 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- DCI:00543519 2017/03/08 NAME: SMITH,TIM SMITH,TIMOTHY PAUL DOB SEX RAC HGT WGT EYE HAIR SKN POB 19750113 M W 602 200 SRO BRO MED IA ADDITIONAL IDENTIFIERS SC ABDOM SC BREAST CCH RECORD *** O1 ARRESTED/TAKEN INTO CUSTODY 19970124 AGENCY: IA0IBO100 CHEROKEE PD CHARGE NO- 01 IA STATUTE IA714-2-2 THEFT 2ND DEGREE TRK#: 015588501 COURT DISPOSITION AGENCY: IA018015J CHEROKEE CO DIST COURT COUNT NO- 01 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 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