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Home My WebLink About13-250 Authorization Number / -c?? 5' � Y 1 (Office Use Only) APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (Police Department review must be made 410 East Washington Street between 8 a.m.to 3 p.m., Monday—Friday.) Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX First Middl t 1. Name --7-/ ✓f/L) j �f I it( Ufr ?/ Ve/5 2. Mailing Address ago] h,A)s � It6 1 ► a Li 3. Telephone: Home l Other: ( 3 19) H 7 1 6 (g .. 4. Prior experience in transportation of passengers: 'ft n e cr } 5 o1 I c& )0 rtfivei 10 Tc\AICA CI l I suole 2 v Nae— , 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsev[Nx'4%.`W,, " :1*.o: Type of offense Where •Whcti""" P;;b 1,c I NT0A, T_C) 1 TV A 5SaU Lf1 -1-L-f i '1 q 7 0 5e 55101/ 'lc1 195 0 A 5o,✓i_f-, �G; i � 'ig 6. Have you be_ep c nvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? y `� 5 Type of offense Where When Speed ill 1./IGj200 9 F�,1 1 'to abs?y «��' c: 3fl SLC , 20 l Z S?eec ) 1)3 fit CJ 20 i 1 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? NC-) 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) NO 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) clerWtaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number . 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 th- provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Ali.. Signature of Applicant i,, ,r J 4 J,/ Date 1 v/ V//,3 / ,rr STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by -1-; r,,,Q . FIJI. -.4-e( kfOn this �-t._ . day of I - . A .• , ,t, WENDY S.MAYER No ary Public in a :?for the State of I�. S' . Cvirrricisw, 4u 729.28 • My Commission Expires 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). X, )o/2V/3 Sigolice Chief or designee "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. z� - i rtiaJ c�/a 9 )3 Signatureof City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 51/2" (height)and prominently displayed to all passengers. *********************************.,..., ******************** .**********************r.,.. ******************,,,,, *.,..********************** Office Use Only Approved application DCI report State certified driving record Website update clerk/taxidrivbadgeapp2010 doc 03/2013 , a . OIowa Department of Transportation �s Office of Driver Services (Td!Free)800332-1121 PO Box 9204,Des Milnes,IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 10/24/2013 DL/ID It: 713)X1449(IA) Customer It: 1833101 Name: Fuhrmelster,Timothy William Class: D ID Status: None Address: 2801 HIGHWAY 6 E LOT 245 Audit A: 7327449 DL Status: VAL Issue Date: 09/10/2013 CDL Status: None City/State: IOWA CITY,IA 522402652 Expiration Date: 08/18/2018 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 1401 MARCY ST Restrictions: Corrective Lenses Restriction None Date of Birth: 8/18/1968 Supplement: Mailing City/State: IOWA CITY,IA 522402117 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 07/12/2009 08/11/2009 592 Speed `Johnson IA 06/19/2011 .07/20/2011 592 Speed(10 mph&under In 35-55 mph zone) Johnson .IA I l— _ _ , 04/19/2012 __ 05/08/2012 __ IMlscellaneous iJackson IA 1...._._..,,_,_.. _.. - ._... 08/03/2012 109/05/2012 (434 'Fall to Obey Traffic Sign/Signal Johnson IIA 09/28/2013 10/17/2013- ,,Miscellaneous Linn ;IA Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 12/04/2008 _ ',485661 IA -{ 12/03/2009543217 -IA� 02/15/2013 - - - - - - _ --- 728650 _ - --- - - _--- _- hIA Name:Fuhrmelster,Timothy William DL/ID:713X%1449 Pursuant to Iowa Cade§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: .011 70. '...•�..•4d 10/24/2013 5*: i*51 a etterierik ,,3..,_•.' D, O. T, :� i• _ q O/'"•�•�La,$= Office of Driver Services Itlycfno�� Iowa Department of Transportation Name:Fuhrmelster,Timothy William DL/ID:713%X1449 r • Oct. 10. 2013 4:34PM Div of Criminal investigation No. 099d P. I .1 • . •: • • 110641- STATE OF IOWA "` '"t% Criminal History Record Check % A- F . Request Form - DCI Account Number:_9967-F (dapp)ieablo) To; Iowa Division of Criminal Investigation From: 'Yellow Cab of Iowa City 'Sopport Operations Form;1"Floor P.O.Boa 428 215 E.t'Street Da Moines,Iowa 50319 • Iowa City,IA. 52244 (515)i2S-60666 • (515)725.6080 Fla (319)338-9777 Phone: Fes: (319)339.7302 X am requesting an Iowa Cdnlloal Hist. Record Cheek cm Last Name(o.renmy) F"uat Name(mmitemsy • Middle Name(,womm«aoal FUknit e,'sM-( 11.Mc tky 1N�`I (.\q H Date.00fHirl)rro,alutamy)) - Gend'er(infedaio.'y). Social-Security/Number(7mjmm�ouaacaj • / 11Cl6 D I�Male ❑itemaie if(65-7& - - Waiver Information; Without a signed waiver from the subject of the regaest;a complete criminal history record spay not be releasable,per Code of Iowa,Chapter 692.2.For camping criminal blatoryrecord ieformattop,a6 allowed by law,always obtain a waiver signature from the subject of the request. - • • Waiver Release:ll.arbyghee pa rkim ardor&bovcmgoeliae oaidd to amt in!swe'oimivalhbwrytroud abed[with de Division ofCrbanua Invmtisuiml()Cb.say Gimbal owarytktom by thgDQ be Sad as slowed by law. • ifaiverSignature: • . ' - • • Iowa(Criminal History Record Clt ck Results • - (DC1int o„y) l As of l 6 I 0 1 ,a search of the provided name and date of bhthreveale& ❑ No Iowa Criminal history Record found with ACI 12, Iowa Criminal History Record attached,DCI# 373 log 6 DCI initials 1 • DCI-77(08/2.5/10) Received Time Oct. 5. 2013 7: 14AM No. 8142 Oct. 10. 2013 4:35PM Div of Criminal Investigation No. 0998 P. 2 • IOWA CRIMINAL HISTORY DCI 00373688 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED- 2013/10/10 DCI;00393688 NAME: FUHRMEISTER,TIM FUHRMEISTER.TIMOTHY WILLIAM FURHMEISTER,TIM FURHMEISTERITIMOTHY WILLIAM DOB SEX RAC HGT WGT EYE HAIR SRN POB 19680818 M Vl 600 200 BLU BRO FAR IA ADDITIONAL IDENTIFIERS TAT L ARM TAT L CALF TAT L LEG CCH RECORD °•` O1 ARRESTED 19080403 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA123-46 PUBLIC INTO/ TRIO; L33958602 COURT DISPOSITION AGENCY: ' IA0520150' JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA123.46 CONSUMPTION / INTOXICATION - 1970 CHARGE CLASS: MISDEMEANOR CONVICTION TRIO: L33958601 SENTENCE DISP EFF DAT PLEAD GUILTY 19880418 FINE $25 19880418 COURT COSTS $20 19880418 02 ARRESTED 19900401 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA204-401-3 POSSESSION.SCHEDULE I/MARIJUANA TRIO: L33958701 COURT DISPOSITION • AGENCY: IA052015J JOHNSON CO DIST COURT CODNT NO- 01 IA STATUTE IA204-401-3 POSSESS SCHEDULE I/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRIO: L33958701 SENTENCE DISP EFF DAT JAIL 1D 19900703 CREDIT W/TIME SERVED 88 19900703 03 ARRESTED 19971005 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA708-2A-28 ASSAULT/CAUSE INJURY/DOMESTIC TRIO: 037285101 Oct. 10. 2013 4:35PM Div of Criminal Investigation No. 0998 P. 3 DCI 00373608 PAGE 2 OF 2 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA236-2-2 DOMESTIC ASSAULT CAUSING INJURY COURT CASE ID: 06521 SRCR045754 CHARGE CLASS: MISDEMEANOR CONVICTION TRIO. 037285101 SENTENCE DIS? EFF DAT SUSPENDED JAIL 28D 19980115 JAIL 30D 19980115 FINE $250 19980115 PROBATION 1Y 19980115 04 ARRESTED 19981104 AGENCY: IA0520200 IOWA CITY PD • • CHARGE NO- 01 IA STATUTE 1A708-2A(28) (38) ASSAULT WITH INJURYIDONESTIC/YNMANCED TRW 044597001 COURT DISPOSITION AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA708-2 ASSAULT CHARGE CLASS: MISDEMEANOR CONVICTION TRIO: 044597001 SENTENCE DISP EFF DAT JAIL 10 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 ENFORCEM�CENCIES BY THE DCI. IN THE A NC CE 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