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HomeMy WebLinkAbout12-105®1�� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) (Office Use Only) 1. Name NIU( SGUj1 fy) 6 2. Mailing Address 6 j� 416 3. Telephone: Home 3) (mc�5cl Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? `i e f Type of offense Where When ac�!p czouY Fcru5 oq 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? •,y Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? NU Type of offense Where When B. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? NG 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) 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) dery m.,drbbadg 09/2010 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number- 7�Y4 �S/� 1 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, 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 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 z4t JUS` Date 61 / 1 /1 #Y4+Y444#41484*f#11M111ff#f1f4MfYYM1k4+44+4iif+R #-444444#**4+f*4+i4*4##1R444*444*4R***f1i*-k*f4***NRR**f****H41114+*41Rf*f*+#f***#44*4«411****4f STATE OF IOWA ) COUNTY OF JOHNSON ) S cribed and sworn before me by t\/ cIQs {/ ji n.L Yee- (� On this L Z da of KELUE K. 7111 LE_ 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). s=aa��a Date `22A Date roved authorized taxi driver names will be placed on the city website at icgov.org. Taxi cab businesses are required to provide Driver Identification cards. „N1N1N11'Y#f11f 4+1«««,«NN1N,N1f 11«411.1fY4««#4NNYN«„««,N,N,..NN«*NN.NNN44.«Nf 1t*-+, ««f«N1N«Nf f f f f.1f..NNN1NN1ilN«N Office Use Only Approved application DCI report State certified driving record Website update dedma vbad9e 2010.d« 09/2010 CA Iowa Department of Transportation Office of Driver Services (roll Free) GM -532-1121 FO Box 9204, Des Manes, IA 50305-9204 515-244-9124 FAX: 515-239-1037 Inquiry Date: 5/22/2012 Name: Trimbell, Nicholas Scott Address: 636 S DODGE ST APT 6 City/State: IOWA CITY, IA 522404836 Mailing Address: 636 S DODGE ST APT 6 Mailing City/State: IOWA CITY, IA 522404836 Convictions Certified Abstract of Driving Record DL/ID #: 700YY9754 (IA) Class: D Audit #: 5200022 Issue Date: 05/04/2011 Expiration Date: 07/13/2016 Endorsements: 3 Restrictions: NONE Date of Birth: 7/13/1978 Sex: M History Information Customer #: 377160 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD Explanation County 3UR 05/09/2003 01/05/2004 A20 _Operating While Intoxicated i7 ,IA___ 07/24/2004 _ _ 01/10/2005 A33 Drug/Drug Related Conviction 17 'IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence ACD Explanation 3UR 05/09/2003 "A90 OWI Test Failu11 re IA Sanctions Type Effective End ACD Explanation Occurrence IUR 3UR I-05/20/2003__ 11/16/2003 OWI Test Failure IA_ IA_ _Revoked _ Revoked 06/27/2005 �; 12/24/2005 _A90_ _ _ A33 'Drug/Drug Related Conviction _ -IA ;IA Name: Trimbell, Nicholas Scott DL/ID: 700YY9754 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: Name: Trimbell, Nicholas Scott DL/ID: 700YY9754 5/22/2012 /t 1OWQ •'PZ,�i .ORNtH S Office of Driver Services Iowa Department of Transportation Name: Trimbell, Nicholas Scott DL/ID: 700YY9754 May. 16. 2012 11:17AM Div of Criminal Investigation No.5224 P. 7/14 Z9" 1011 09S:01, 6106 'H 'ARN awil P3A10aag STATE OF IOWA Criminal Mgtory Record Check. Request Form M Tot Iawa Dlvlrlao orcrlm)nal Invesdaatlah support operadour Burao, I" Floor 219 L 7" street Des Mainea,IoWa 50319 (515) 7356066 (313) 7356080 Fax DCI Account Number- 4313—Fr- (if (ifaMiuble) From: Mi%yC.s 1 0.x1 rj.4tvtw5 ©r o�� C saaK O Phooel ,(�I9� 338' arl'i' Fax:, . 319 551'82q ' 1 am nestin onIowa urimrn aro Last Name ff N w news, . ,.a n �... FI"lrk(ame mmm Oddle Name Date of Blrtb ow-d-aw Gender aweeen Soelal Security Number ,am 0 -1)/2f WalverJ'nfayrtnt%0tt: Without aalpaa0WALVerfrom the eublectortberequest, atompltrecrlm(oalbhtory record my'lot be rateaaable, per Code of Iowa, Chapter 6917. For coln2jgts crimlaal hbtorr reeord lalormattoo, as allowed by law, atwayx obplaewatveral Nerelkemtdeaubea<ofthet dt. hMbY 81" ka(of 00 to wnhUM ?on maid wlNon OlvbionorGimid "Ima M ft on mym mleeandu 141oewryad by w`bxi 1WNIVer "aggaiabPCO Na history am:eanln num NmsbrqflT0W Wrim►StRuatorr. Iowa /Criminal History Record Check Rcsalts As of.5-10—Z2::(DCI ase aNy) —10 --Z� , a search of tna he provided me and dato of birth revealed; r.) ' ❑ No Iowa Criminal History Record found with DO Iowa Criminal History Record attached. DCI DCI initials May,16. 2012 11:17AM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00620515 FELONY CONVICTION PAGE 1 OF 4 DATE PRINTED - 2012/05/16 DCI:00620515 NAME: TRIMBELL,NXCHOLAS SCOTT DOB SEK RAC HGT WGT EYE HAIR SKU POB 19780713 M W 509 170 BRO 13RO FAR IA ADDITIONAL IDENTIFIERS TAT BACK TAT R LEG TAT UL ARM CCH RECORD ••* 01 ARRESTED 20000512 AGENCY: IA0070100 CEDAR FALLS PD CHARGE NO- 01 IA STATOTE IA123-47(1) PROVIDING ALCOHOL TO MINOR TRK#: 600115601 COURT DIBPOSXTION AGENCY: IA007015J BLACK HAWK CO DIST COURT COUNT NO- 01 IA STATUTE IA123-47-1 PROVIDING ALCOHOL TO MINORS CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 600115601 SENTENCE FINE $250 PROBATION lY SUSPENDED 60D 02 ARRESTED 20010723 AGENCY: IA0070100 CEDAR FALLS PD CHARGE NO- 01 IA STATUTE IA124-401-5 POSE MARIJUANA TRK#; 600041401 CHARGE UO- 02 IA STATUTE IA714-2-4 THEFT 4TH TRK#: 600641402 COURT DIOPOSITXON AGENCY: YA007015J BLACK HAWK CO DIST COURT COUNT NO- 01 IA STATUTE IA124.414 POSSESSION OF DRUG PARAPHERNALIA COURT CASE ID; 01071 SRCR107637 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 600641401 RESTITUTION SENTENCE FINE $50 COURT DISPOSITION AGENCY: IA007015J BLACK HAWK CO DIST COURT COUNT NO- 02 IA STATUTE IA714.2(4) THEFT 4TH DEGREE - 1978 DISP EFF DAT 26000912 20000912 20000912 DISP EFF DAT 20021015 No.5224 P. 8/14 May.16. 2012 11:17AM Div of Criminal Investigation DCI 00620515 PAGE 2 OF 4 COORT CASE ID: 01071 SRCR107637 DISP EFF DAT CHARGE CLASS: MISDEMEANOR CONVICTION SO TRX#: 600841402 SUSPENDED JAIL 115D RESTITUTION JAIL 120D SENTENCE FINE DISP EFF DAT SUSPENDED JAIL 30D 20021016 FINE $250 20021018 PROBATION 2Y 20021018 03 ARRESTED 20030509 AGENCY: IA0070000 BLACK HAWK CO SO CHARGE NO- 01 IA STATUTE IA321J-2 DWI IST OFFENSE TRK#i 601141201 COURT DISPOSITION AGENCY: IA007015J BLACK HAWK CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2(A) OPER VEH WE INT (OWI) / IST OFF COURT CASE ID; 01071 OWCRI14032 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 601141201 DRUNK DRIVING SCHOOL LICENSE REVOKED SUBSTANCE REUSE EVALUATION RESTITUTION SENTENCE DISP EFF DAT TIME SERVED SO 20040106 SUSPENDED JAIL 115D 20040106 JAIL 120D 20040106 FINE $1000 20040106 PROBATION 2Y 20040106 04 ARRESTED 20040724 AGENCY: IADD70100 CEDAR FALLS PD CHARGE NO- 01 IA STATUTE IA124.401(5)(M) POSSESSION OF MARIJUANA TRK#: 601629101 COURT DISPOSITION AGENCY: IA007015J BLACK HAWK CO DIST COURT COUNT NO- 01 IA STATUTE 1A124,401(3)-2 POSSESSION CONTROLLED SUBSTANCE, MARIJUANA COURT CASE ID: 01071 SRCR124512 CHARGE CLASS: MISDEMEANOR CONVICTION TRX#: 601629101 LICENSE REVOKED SUBSTANCE ABUSE EVALUATION No -5224 P. 9/14 May.16. 2012 11:18AM Div of Criminal Investigation No.5224 DCI 00620515 PAGE 3 OF 4 SENTENCE DISP EFF DAT COMMUNITY CORRECTIONS 20050110 SUSPENDED JAIL 60D 20050110 FINE $250 20050110 PROBATION 2Y 20050110 IMPOSED PROBATION 20061207 REVOKED PRISON 20061207 TIME SERVED 60D 20070529 COURT DYSYODITION AGENCY% IA007015d 'BLACK HAWK CO DIST COURT COUNT NO- 01 IA STATUTE IA714.2(5) THEFT STH DEGREE - 1976 COURT CASE ID% 01071 SMCR124519 CHARGE CLASS: MISDEMEANOR CONVICTION TRKN% 601629102 SENTENCE DISP EFF DAT FINE $50 20050110 05 ARRESTED 20060621 ' AGENCY: IA0070300 WATERLOO PD CHARGE NO- 01 IA STATUTE IA713.5(A) BURGLARY 3RD DEGREE TRK#: 602417201 COURT DISPOSITION AGENCY: IA007015J BLACK HAWK CO DIST COURT COUNT NO- 01 ' IA STATUTE IA713.6A(1) BURGLARY 39D DEGREE COURT CASE ID: 01071 FEC9140391 CHARGE CLASS: FELONY CONVICTION TRKP: 602417201 RESTITUTION SENTENCE DISP EFF DAT COMMUNITY CORRECTIONS 20061113 FINE $750 20061113 SUSPENDED FINE $750 20061113 SUSPENDED PRISON 5Y 20061113 PROBATION SY 20061113 PRISON SY 20061113 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 THB 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. P. 10/14 May. 16. 2012 11:18AM Div of Criminal Investigation Mo.5224 P. 11/14 DIVISION OF CRIMINAL INVESTIGATION