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Home My WebLink About17-145� r 1 .06.0 lqr �t.Y.._ CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-SO40 (3 19) 356-5497 FAX IDENTIFICATION NO. 1 — I `T 5 - (Office (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 �, Middle, st ` i 1. Name (REQUIRED) I ) M �11 I `t t c� t- Fir) f M t IL2. Address (REQUIRED) 7,2n N' . 1D l-) rj o o V e # - I TOAs Q _j+X 3. Contact Information (REQUIRED) Email: VA6- ellPhone: (319) 393 - (All written communication tiV mmunication ss nt Iva email) 0 4a. Driver's License expiration date (REQUIRED) ( 1 6 ( b. Taxicab Business Name (REQUIRED) 7 e 1(o �) C uAo Of -c" a1 C, 11'y 5. Prior experience in transportation of passengers: —EC>,AJol C +\f S22tt 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Y t �> Type of offense Where When Pvol%t- 1'11 -VA 'l-j"Vu city 19 8 What happened tothe charge? (Circle one) -T--d-0a Cl 19g ►q ,? avlrl S Convicte Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? N n Type of offense What happened to the charge? (Circle one) Where When 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? 00 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 ft name(s) rt "t C7 rCDs "IF" DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND ST DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLIC You must apply for an individual Department of Criminal Investigation Report (form (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) Upon rwest) w13 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 hereby certify that I hav issued to me by the Iowa Departme t of Transportation a alid Driver's license number 'j 13 X issued on O V piring on �J 1 l I s� . 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 f Title 5, Chapter 2, of the qty Code. (Needs to be signed in front of a Notary Public) Signature of Applicant DateV 'Ir STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by Aap+J LA , ?; . & �� Jyj-on this / day of r), lt-6)6 F Zo)-) in and/Orthe State of 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). license r designee Yl 12 ' 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. Sign ture of City Clerl or designee Date Clerk/rAXIDRNB4DGEAPPL92014am dW.DOC 07/2016 Office Use Only cm Approved application >:; —4 DCI report State certified driving record :< M Website update rT� Clerk/rAXIDRNB4DGEAPPL92014am dW.DOC 07/2016 Uct. 9. 2017 8:35AM Div of Criminal Investigation to/u�ituri 14:50rellow Cab OT rowa Lity (FAX)31B33B2iNo. 3068 P•r,UO2/002 STATE OF IOWA Criminal History Record Check Request Form y �t To: town Dlvlelon atCriminAI Inventigatioh Support Operation$ bureau, 111 Floor 216 X 711 Street DO' Moines, Iowa 50319 (515) 725.6066 (515) 725.6080 Fax I em renueatinv nn tnwa rA—i-.1 w.,,.._, n ___ DCI Account Number: „9967-F (Irappkable) Frotal Yellow Cab of Iowa City P.O. Box 428 I01va City, IA. 52244 Fbone:. (319)338.9777 Fax, (319)339-7302 ......... Lost Na ..--u.0 1.111. VII. 1~'irst Nama mandato MiddleNatme (Mommended) =mmdatoty) FDate of Gender (mandatory) soclal Securt Number(gmmmended) 41/1q/65 ate ❑Female 4 � 5 —7G - a7 1fa Walver LIlormallon: Without a signed waiver from the subject of the request, a tiompleta criminal history record may not be releasable, per Calla of Iowa, Chapter 692.2. Far Complete criminal history record Information, as allowed by taw, always obtainY Iv 1 a ure from thesub ect of the re uest. Waiver RdldaSd; I hereby alve permission ror Ne above rtquesnng omclw to conduct on lows odadnd bl"rewid ehvok wlth sho nlvldon vtComiul Invelllgulon (M). My cnminst hlatorydere eoneeml : that Is mants)ned by she VCt be relcued m al wed b 1111Y. WalverSlgnalrrres�/f/� LV xIq ..,a ssusuiss r11,rury xecora L necK mesuits =I use ants) As of Jo -q- a searoh of the provided name and date of birth reveeled: G r No Iowa Critninal History Record found with DCI n -C rn -o m Tows Criminal History Record an bed, DCI # 3 } 3i0 82 _. w DCT frildals DCI -77 (08/25/10) Received Time Ocl. 5. 2017 3:10PM 1,0.1999 Oct. 9. 2017 6:35AM Div of Criminal Investigation IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI:00373688 NAME. FUHRMEISTER,TIM FUHRMSISTER,TIMOTHY WILLIAM FURHMEISTER,TIM PURHMBISTBk, TIMOTHY WILLIAM DOB SEX RAC HGT WGT 19680816 M W 600 200 ADDITIONAL IDENTIFIERS TAT L ARM TAT L CALF TAT L LEG DCI 00373688 PAGE 1 OF 2 DATE PRINTED - 2017/10/09 EYE HAIR SKN POB BLU BRO FAR IA CCN RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 19880403 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA123-46 PUBLIC INTOX TRK#: L33950601 COURT DISPOSITION AGENCY! IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA123.46 CONSUMPTION / INTOXICATION - 1978 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33958601 SENTENCE PLEAD GUILTY FINE $25 COURT COSTS $20 02 ARRESTED/TAKEN INTO CUSTODY 19900401 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA204-401-3 POSSESSION. SCHEDULE I/MARIJUANA TRK#: L33950701 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA204-401-3 POSSESS SCHEDULE I/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TR"; L33956701 SENTENCE JAIL 1D CREDIT W/TIME SERVED OH 03 ARRESTED/TAXBN INTO CUSTODY 19971005 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA708-2A-2B ASSAULT/CAUSB INJURY/DOMESTIC TRK#: 037285101 DISP EPP DAT 19800418 19880418 19880418 DISP EFF DAT 19900703 19900703 No. 3068 P. 2 N 0 J C-) D --i L� � �rn -o M &� W W Oct. 9. 2017 8:36AM COURT DISPOSITION AGENCY: XA052015J COUNT NO- 01 Div of Criminal Investigation JOHNSON CO DIST COURT IA STATUTE7 IA236-2-2 DOMESTIC A68AULT CAUSING INJURY COURT CASE ID: 06521 SRCR045754 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 037285101 SENTENCE SUSPENDED JAIL 26D JAIL 301) FINE $250 PROBATION lY DCI 00373688 PAGE 2 OF 2 DISP EFF DAT 19980115 19980115 19980115 19980115 04 ARRESTED/TAREN INTO CUSTODY 19981104 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA708-2A(2B)(3B) ASSAULT WITH INJURY/DOMESTIC/ENHANCED TRK#: 044597001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708-2 ASSAULT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 044597001 SENTENCE DISP EFF DAT JAIL 1D 19990223 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 DCT, 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. 3068 F� CD c') -4 P. 3 r M D 6Iowa Department of Transportation MNCoca ct Other serriees (T011 Ftee)8DD-532-1121 PO 8W 9M, 00 Moires, IA 51130&9204 51524411124 1"11111w, FAft 515.2391837 Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Name: Fuhrmeister, Timothy William DL/ID: 713XXI449 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 Office, and that I have been authorized by the Director of the Iowa Department of Transportation to so certify. _ N �7 `-� J In witness whereof, I have caused my signature and the seal of the Department to be set upon this dgy'Tnt, Rnkeny,gwa this date: ?y� --1 r Q�latf 10/5/2017 M D. 0. T. -. Office of Driver Services Iowa Department of Transporation Certified Abstract of Driving Record Inquiry Date: 10/5/2017 DL/ID #: 713XX1449 (IA) Customer #: 1833101 Name: Fuhrmeister Timothy William Class: D ID Status: None Address: 2801 HIGHWAY 6 E Audit #: 7327449 DL Status: VAL LOT 245 Issue Date: 09/10/2013 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 08/18/2018 CDL Cert Status: None 522402652 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 1401 MARCY ST Restrictions: Corrective Lenses Restriction None Supplement: Date of Birth: 08/18/1968 Mailing IOWA CITY, IA Sex: M City/State: 522402117 History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Name: Fuhrmeister, Timothy William DL/ID: 713XXI449 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 Office, and that I have been authorized by the Director of the Iowa Department of Transportation to so certify. _ N �7 `-� J In witness whereof, I have caused my signature and the seal of the Department to be set upon this dgy'Tnt, Rnkeny,gwa this date: ?y� --1 r Q�latf 10/5/2017 M D. 0. T. -. Office of Driver Services Iowa Department of Transporation Name: Fuhrmeister, Timothy William DL/ID: 713XXI449 m_ O J C) 1 LD