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Home My WebLink About17-094♦ IDENTIFICATION NO. 1 —7 — 1 i I (Office Use Only) i�+�Mlroar�,l CITY OF IOWA CITY 'APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday) 410 East Washington Street Iowa City, Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application (3 19) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name (REQUIRED) . /4,% • In cTS 2. Address (REQUIRED) _//" 41iX.! Jl 3. Contact Information (REQUIRED) Email: /=/'( .' / ; d ; E, ,' y �� .(�M CellPl�one: 19 rl3 c Y »� (All written communication sent via email) m� C 4a. Driver's License expiration date (REQUIRED) �� f/`l� n� r- 21,013 �Co — b. Taxicab Business Name (REQUIRED) � i/o.r <<,� - m b 5. Prior experience in transportation of passengers:es Ti 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where /r When Gy 1 A lcn�,•.1 1� ( /. What happened to the charge? (Circle one) Convicted Dismissed DeferredSuspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where /W When .N v M.i ✓!t; �C.c lc ._ _ 1. Jf; l h What happened to the charge? (Circle one) Convicted Dismissed Deferred usp dem Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? VIIP!�j Type of offense Where When -21 c /ly f-:1 �o P s+ f yr �Sr 4'1cn� C�/�� Orli 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) hu 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 ./ APPWCATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation vsalid Driver's license number j S � CC - %Y6 issued on ��L1 7 expiring on �. 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, 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 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and swornto before me by TuL14� lir )t<-tc� pn this 7 —� day of .t�'4 VdENDY S. MAYER Commission Number 729428 �! Public in arfd for the 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 ��/ 2�af Signature of Police Chief 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. j G � at7' 7 Signure of City Clerk r designee Date r Office Use Only ., c r Approved application M DCI report za State certified driving record Website update o �.n Clerk7AXIMIVBADGEAPPL92014ameMed.DGC 07/2016 J I. L7• LV II IV:70MI,UIV o Ur lmi nal I n v e s lgat ion Fro m:�-iry o, ibwo ury Cl crk �n,bo mler :.'bC b...,, i i No -3424 P. 1/2 07/20/2017 118:1. w142 ,- /002 STATE OF IOWA C1rilL>hkal Higtory Recok-d ChaCk �a Reauegt Foo^reg rDCI Account Number: 1-(00 T (if applicable) – To: lowa Division orcriminol Investigation From: & aflowa Cify _ Support Operations Bureau, 1" Ftoor City Clerk's Office 215 E. 7"' Street 410 )r. Washblaton gtrect Des Moines, lows 50319 M40 (515) 725-6000 Fax — Phone: 319-356.5041 Fat: 319-356-5497 i am re uestin an Iowa Criminal histol ' Record Check on: Last Naine (mandoloq•) First Nalne (,uandaton) Middle Name (reconvoendeJ! Date of Birth (mnndabry) Gender (n,annata,y) Social �ee¢rify Number (mommended) '7/ Okale ❑Female Y6 (% Waiver Mforination: Without a signed waiver from the subject ofthe request, -2 complete criminal history record may not be reteasable, per Code of Iowa, Chapter692,2. For complete criminal history record information, as allowed bylaw, always obtain a waiver signature from the subject of the re uesf. N"ailler Release; hcrchygive pemussion for —the «gaesnno official to conduct an Iowa criminal historytecord ch eel: with the nivision of piminnl Investigation (M), Ally criminal history dale concerning me that is maintained by tbcoCI may be released as allowed by law. PYadverSigttafttre;G� � _ l �„ - _O Iowa Criminal �]fis�ar�r iiecord Check Results As of 71 'Z! S— — 1 7L a search of the provided name and date of birth revealed; ❑ No l0wa Criminal History Record found with DCI Ci�-.Towa Criminal A.istory Record attaclied, DCT # 4 Lid-I/kuziu IU) Received Time Ju 1.20. 2017 3:51 PM No. 3243 (DU use only) C • cvii Iv.7VAJVI viv of i,riminai investigation IOWA CRIMINAL HISTORY DCI 00676636 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - DCI :00876636 2017/07/25 NAME: WILMOTH,TALLEN MIKEL DOB SEX RAC HGT WGT EYE HAIR SKN POB 19910605 M W 511 155 BRO BRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT SACK CCN RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 20091004 AGENCY: IA0520200 IOWA CITY PD CHARGE 140- 01 IA STATUTE IA700.7(4) HARASSMENT / 3RD DEG, - 1989 TRK#: IA007VO01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- of IA STATUTE: IA708,7(4) HARASSMENT / 3RD DEG. - 1989 COURT CASE ID: 06521 SMSM078168 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1AD07VO01 SENTENCE DISP EFF DAT SUSPENDED FINE $100 20091103 FINE $100 20091103 PROBATION lY 20091103 COMMONITY SERVICE 14H 20091103 02 ARRESTED/TAKEN INTO CUSTODY 20121227 AGENCY: IA0920000 WASHINGTON CO SO CHARGE NO- of IA STATUTE IA123.47(3)(A)(2) POSSESS/PURCH OF ALCOHOL UNDER 21 2ND OFFENSE TRK#; 14X0012301 COURT DISPOSITION AGENCY: IAD92015J WASHINGTON CO DIST COURT COUNT NO- 01 IA STATUTE: IA123,47(4) SUPPLYING ALCOHOL TO PERSON UNDER AGE COURT CASE ID: 00921 SRIN009705 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: NK0012301 SENTENCE bISP EFF DAT FINE $315 20130403 AN ARREST WITHOUT D1SPOSITION 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 SY 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 No - 3424 P. 2/2 C410WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN www.ioYyadot.goy i Office of Driver Services PO Box 9204 1 Pas Moines, IA 50306-9204 Phone: 515-244-91241 800-53.-1121 1 Fax: 515-239-1837 www.bvratloLgov History Information Convictions 'itation Date Conviction Date _ �- 02/21/2014 --- Certified Abstract of Driving Record _ Explanation �No Insu------- _ Card Inquiry Date: 7/19/2017 DL/ID #: 152CC6946 (IA) CDL Permit Class: None Customer #: 4537022 Class: C COL Permit Issue Date: None Name: Wilmoth, Tallen Mike] Audit #: 1760928 CDL Permit Expiration None Date: Address: 1100 ARTHUR ST APT C2 Issue Date: 04/20/2017 CDL Permit None Endorsements: Expiration Date: 06/05/2025 CDL Permit None City/State: IOWA CITY, IA 522406607 Endorsements: NONE Restrictions: ID Status: Mailing 1100 ARTHUR ST APT C2 Restrictions: NONE DL Status: VAL VAL Address: Restriction None CDL Status: None Mailing IOWA CIN, IA 522406607 Supplement: City/State: CDL Permit Status: ELG Date of Birth: 6/5/1991 Sex: M CDL Cert Status: None CDL Med Status: None History Information Convictions 'itation Date Conviction Date _ �- 02/21/2014 --- ACD_ --� _1864 _ Explanation �No Insu------- _ Card County _ _ - - _ ]UR --- -- 71/24/ ---- 2014 ri/24/2014�__.--- , lI �"11�F OHI�YEB,°s 02/21/2014 ---� -�- ;593 -rance Speed pohnson - �- 13ohnson - 7A _ - IA - - Accidents - Accident involvement indicated does NOT mean the Individual was at fault or given a citation. Accident Date _ Case Number ]UR )1/21 1 /2014 __ 8888.7815 1781594T.A _ _ __8888 Sanctions type Effective End ACD Explanation _ Occurrence JUR ]UR --___.T.._.__.. _ _._...88..88,_. iusPended 03 20 2014 - 7777-- - `--'—'--' _ - - — - - / / 101/20/2015 ID36 Fail to Post Security for Accident -Driver Only ,IA IA Name: Wilmoth, Tallen Mike[ DL/ID: 152CC6946 Pursuant to Iowa Code §321.10, 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 offic been authorized by the Director of the Iowa Department of Transportation to so certify. e, and that I have 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: p�{IICIf p'4i i o�`�e''��✓'i:q 7/19/2017 IOWA ?'s D... T. , lI �"11�F OHI�YEB,°s of Services ofwaeDepar]tme Department of Name: Wilmoth, Tallen Mikel DL/ID: 152CC6946