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Home My WebLink About12-253� r 1 �1 rlll� CITY OF IOWA CITY 410 East Washington Street �65 240-1826 (33X 1. Name 2. Mailing Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) a- all:�3 (Office Use Only) 3. Telephone: Home 4. Prior experience in transportation of passengers: Other: 7//Q- 9/w -A59 ?,F 5. Have yon ever bees, convicted of any misdemeanors and/or felonies in this State or elsewhere? / ".f r& Type of offense Where When 061V I 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years?IK-1 Type of Offense Where Have you been convicted of any traffic offenses in the last five years? 7Cl When Tvpe of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 142;� 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) derklte idrlvbadg 09/2012 yzs'xx L&gr7 I hereb certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number ..... �� 4 412.YXr b 4 YP 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, 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 : �= Date #*#***##4#***FFµ*Y***##*++##FFFFµ**µµ**+*#+#44+##****k***FF*FY**+########*FF*FFµ FFFYYF##*Y##+F****F*F*F*µ*Y**#####**##*#***#F**µµ*#µ#####F**Fµµµ STATE OF IOWA ) COUNTY OF JOHNSON ) Su sar ed anc sworn to Lefore f -j --7 -P Iia fyL +1tA On this R-H-,� day of 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). Si�inature of Police Chief or designee %0 -.7Z Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. SignMwe of City Clerk or designee Taxi cab businesses are required to provide Driver Identification cards. /If -a.2- -/a.. Date #R*******µ###****#+++*###+###**R****RF*h##*++#+**+#+###*#R**#h**R##*#**####+++H++####*RR***FRRR#R*#***#######+###*##*R*FRF#FF*R*F####*****##*## Office Use Only Approved application DCI report State certified driving record Website update a Wn dew dgeappMO a 09/2012 I me by 1 Oct.17. 2012 10:19AM Div of Criminal Investigation •. I. I V. L V 1 L L. L J 1111 V I l J u I I, I h V I l/ V 1 &V It P V I l lNo, 98121 [P. 11/3 I g TYlel ! I i/I \ I I ;� wAIS A`11�jIF�''C f ' I il.: I M ', 1R . 1 1d Cheok Raque'qt Form .a ryryibi,lli VjY.�. u Ig1Po7J Y ' � To: roWab19r9fortorcriminal rnvostlgarton Support Ppora(rona fauronu,l't$loor bes)VSpfnas,To)vq 90319 (815) 7gwged (515) 729--6090 1Fn7c L om reaue Iia /n A", (I: Record Cheolc ow 0 7RIMP 7�C1A000ankNUmbar: �huU'�- �J ' opylloaD e) VrOms CITY of 1=OYA CITY CITK zZWS omzaig 410 R 'MmurnT6ToN anL'RBT TOVA CTTY' XQUA. 52240 khoaer X319 356—SnaY 1raX1 qY9 aKF 5497 So • OJC+eIwaTe It yCi 2 p� N'r)dyehlnfarltltlYPnY7:1X'ithout a slgaed a'ANerltiom tfia suhf ecc oCtha Yet�navt, a tomplele oF1nt(nal hlsfol'y reDo)'d may )]oc berde:01161e, per Coda ofyo•{yp,Chap{erAM.Frcohi IerecriminplhlstpryrecoyrilnPokMatlalY,adalloWodNylNWi,plWgys obtatina waWerslanafum lnnithe..crth(ect nf9&n YeeVecf: Y liQrQliSg;lhcrcEy®tvopermtsy(entbrtocecr)mrnd rnr�sUgatron(OC�.,lytyol'tntMalLreforydnMapnumfn6mothausmarnmine46ytRengimp�•6orerearedasarroweQ6yr5ty Jlowa Urbillba.11astory-Reeorc Qrhecka�e�lrltd . taclu�earr� A.s of a 9ewh oftlw provided name and dgCe of birth -revealed: No rowar CkjmbullBstorykecord fowid whh= 1.1 loft ariminal1 isforyRocord attaol)cd, bC.i initia'als� Received fi•ime"bcf, 10. 2012 2:23PM No, 4947 Oct. 17. 2012 10:19AM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00663656 COURT DISPOSITION PENDING PAGE I OF 1 STATUS UNKNOWN PATE PR1NT$b- 2012/10/17 DCI:00683656 NAME; PAINTIN, THOMAS MICHAEL DOB SEX RAC HGT WGT EYE HAIR SKN POB 1999102B M W 509 150 BRO SRO IA ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED 20021024 AGENCY; XA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#; 100696401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2(A) OPER VER WH INT (OWY) / IST OFF COURT CASE Ill; 06521 014CR063604 TRK#+ 100696401 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DEFERRED JUDGEMENT PROBATION 365D No.9821 P. 2/3 DISP EFF DAT APPEAL DATE 20040603 20041203 20040603 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE 1014A 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 0) CA Iowa Department of Transportation Office of Driver Services (Toll Free) BM -532-1121 PO Bot 9204, Des Moines, IA 50306-9204 515-244-9124 FAX: 515-239-M7 Inquiry Date: 10/19/2012 Name: Palntln, Thomas Michael Address: 204 SUMMIT ST City/State: OXFORD, IA 523229712 Mailing Address: 204 SUMMIT ST Mailing City/State: OXFORD, IA 523229712 Convictions Date Conviction 12/11/2010 _01/25/2011 06/04/2012_ 07/06/2012 06/04/2012 07/08/2012 Certified Abstract of Driving Record DL/ID #: 428XX6697(IA) Class: A Audit #: 5134429 Issue Date: 04/05/2011 Expiration Date: 10/28/2016 Endorsements: NONE Restrictions: NONE Date of Birth: 10/28/1979 Sex: M History Information Customer #: 2841190 ID Status: None DL Status: VAL CDL Status: VAL CDL Cert Status: None CDL Med Status: None Restriction None Supplement: ACD Explanation County 'A20 Deferred judgment OWI X52 69.2 .. _ Speed (10 mph & under In 35-55 mph zone) 52 Improper Registration .52 �.r� Miscellaneous__. 52 Vehicle Overweight , 52 Operating While Intoxicated Test Refusal/Test Failure Violations .7UR ...... ...SIA.._ IA IA IA Occurrence ACD Explanation _ _ JUR .._...... .......... __r.... 10/24/2002 ;A90 ;OWI Test Failure IA Sanctions _Type Effective End ACD Explanation Occurrence 7UR 7UR 042002 ;05/03/2003 / / Revoked :11 _ ' .._.�»......,-w..........:.._ _., i_.. _ 3_. ___..�. � €A90 :OWI Test Failure ]A � �;IA� Name: Palntin, Thomas Michael DL/ID: 428XX6697 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: ' • .�T/;P 10/19/2012 IOWA 'c, C446 'e4vilm=4 NIVE6 Office of Driver Services �.r� Iowa Department of Transportation