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Home My WebLink About12-030CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 3S6-5040 (319) 356-5497 FAX Authorization Number a —150 (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) Last 1. Name 2. Mailing Address 1,14Z t/Aly (Ua 3. Telephone: Home 3,0- 3 z S 3 8 3 Other: 4. Prior experience in transportation of passengers: Ale *� 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? )a S Type of offense Where When s a3 f� r c�.l �cT//4 lg� 6. Have you been ciinvicled of operating a motor vehicle while unc!Wthe influence of alcohol or drugs in the last five years?t'f z_ Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? NO Tvpe of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /V^ Tvoe 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) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) cle6dtaxidriWadg 09/2010 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number 5-j,& ;_� z- ya 7 z . I understand that if I falsely answer any questions in this application, that this application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will be denied. I agree that in making this application, 1 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 a license 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 /D / Z STATE OF IOWA ) COUNTY OF JOHNSON ) sgibed and swam to before me by I Y�'10 l l—��Y�('t V� . On this day of 2-0I 2_ 1191 :r 2218191 Notary Public 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 deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). Signa a of Po a hief or designee Signature of City Clerk or designe Date Date After Police Chief and City Clerk have approved authorized taxi driver names will be placed on the city website at icgov.org. Taxi cab businesses are required to provide Driver Identification cards. fffM4M141f}!'ff!lMYMfllffffflffH!!HlHlMYff!lfHlHlffHHlYHIfHIHlHlHfllHfHfffHHH11fM*#fHlff4fR4fffMf+1:YM+M44Mf4Rf44MfY Office Use Only Approved application DCI report State certified driving record Website update clerWl dnvbadgea,2010.dm 09/2010 Iowa Department of Transportation Office of Driver Services (Toll Fme) OW -532-1121 PO Box 9264, Des Maines, lA 5O3O692O4 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 2/3/2012 DL/ID #: 556ZZ4072(IA) Name: Smith, Timothy Paul Class: C Address: 1492 VANDELLO CIR Audit #: 4396333 Iowa Department of Transportation Issue Date: 06/02/2010 City/State: NORTH LIBERTY, IA Expiration 01/13/2013 523178045 Date: Endorsements: NONE Mailing Address: 1492 VANDELLO CIR Restrictions: Corrective Lenses Date of Birth: 1/13/1975 Mailing City/State: NORTH LIBERTY, IA Sex: M 523178045 History Information CLEAR DRIVING RECORD Name: Smith, Timothy Paul DL/ID: 556ZZ4072 Customer #: 2042987 ID Status: None DL Status: VAL CDL Status: None CDL Cert None Status: CDL Med None Status: Restriction None Supplement: 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 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: ........ f�%'4� 2/3/2012 IOWA a/ ). 0. T. .0...... Office of Driver Services Iowa Department of Transportation Name: Smith, Timothy Paul DL/ID: 556ZZ4072 : Feb. 9. 2012 432PM I J. LV IL 4:32 111 Div of Criminal Investigation No, 3346 P. 5/6 City VICIa V I t y VI LUWa �I,y . No. evu't P, L IMMA-MAOry Record Chec➢ `ICC��N�'dp�l'�y b RequeatForm �iv'tj '!Fly �'o; 1oNaDf4;xioxefCrfmin4lTnVesttg'atteh Support apera0ons &uroau, I" Wooe 216, 71hSireet boslvlalrl000lva 50319 (s)s) i2g•6066 (615) 725-6080 NaYc ACIA000untMmber: L- 00a--- 1~ peO@y(Metc) FYom{ • QITV 037 IOWA CITU CITY CLUK*5 0111MC)3 410 r+, WA sgrr MIT SMET IOWA CITT TOVYA 52240 Phone; R19—t156�5041 Nnxr 31 o-�F�54.47 . .t.raSL NAkne (mandatory) ' M"t Name (nandOtOrA) I Middle Name acommellded) RafeofDirtIt(MmmorA 06hdoa' manddlo) SOefal96DUkj IQ` Ojei r0001n01chdad aiYeFY11,/oJ7yJafloh; WffhoutastgnodwaYOr*omthe, siQectofthe ragneA)aeomplatocrl lulhfstoryrecordntayhot ho rdlasubre, per, Code ofYotvn, Chapter 69z.2,P'or cotnnlotn'dr(mtnalhistory recordlafermatloa, as atTowob Ky Invs, ql{yays obtain vatvorsl olorod'onl tho•sub octoftharc h; WrziveYReCepy�a;Ihetr6yglVapermissfoat6rdrea6everequesnegoltTotpllomnduattm7avincHmldalfilstmyteeorddtWcwilhuleDiYtvtonolCrimino( , YoYestigalion WID. Aqy orlp$nal MsldtyJalo ednccmMg niolbat7smain[/l%ned dytho D0lmlybo released at e(folxed Dy I;w. WalverStQndlu►e;� • WVF[ lAAJ4A"AH{.I1.4;ALV{,',;,4V;:U{µ•lam;;V VA\A'U, L1(L15 l�Cl arO only) A swop of the. provided came and data oMahx'owealed. .. �( �o Sows G'l,unineX H,lstary ltecprd fowtd witft DCI I.I � ; ' , Xowla Cximinal history Rewd attached, DCT # Ski 3 5/ bCYs"uitiels Received Time Feb, 1 2012 9:40AM No. 8053 Feb. 9. 2012 4:33PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00543519 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2012/02/09 DCI:00543519 NAME: SNITH,TIM SMITH,TIMOTHY PAUL . DOB SEX RAC HGT WGT EYE HAIR SKN POB 19750113 M W 602 200 BRO BRO MED IA ADDITIONAL IDENTIFIERS SC ABDOM SC BREAST CCH RECORD *** 01 ARRESTED 19970124 AGENCY: IA0180100 CHEROKEE PD CHARGE NO- 01 IA STATUTE IA714-2-2 THEFT 2ND DEGREE TRK#: 015588501 COURT DISPOSITION AGENCY: IA018015J CHEROKEE CO DI$T 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 MON-LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION TRIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION I No.3346 F. 6/6