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Home My WebLink About13-052i r 74r'lll� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-504 (319 AX 1. Name 2. Mailing Authorization Number 1-5�- S2 - (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) 3. Telephone: Home 316%C7 / 01 /02 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? AzL" YP Type of offense Where When 701-.,,rcr, C01AA44 L7- /5'P l 6. Have you ben convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? � b Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? NO Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ,UL TVDe 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) derkR dnWadg 09/2012 e I hereby certify thatI have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number a.l 2 �dC.2 t :22 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 ---_ Date STATE OF IOWA ) COUNTY OF JOHNSON ) L � /i L COh/P2Tc ib�,� and sw9 n t before me by ko7C On this day of 1 KELLIE K. TUTTLE 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). Sig ture of P Iq 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. Signat6re of City Clerk or designee Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update ?-5-/3 Date deW idrhAaageapp= 0. a 0912012 Mar, 4. 2013 2:53PM FAX 2013 10:OOAM PJ N Div of Criminal Investigation City Clerk - City of Iowa City. W No. 5199 P. 1 No, 3276 P, 2 ROME K, ti x:�% .,r r, 'WrC•j0 D��1. r + Form . 1:: •..r5l(e ` Tor Xo1VA)DfVW0trafCx1mbA11hVestt9arton Support Ope1,e0toDrsA1jroqu,111VAor av J;.7'hsfreot Pea mphieP,,%WA �faYY9 (31s) 7a5.6o6d (515)12G--6080 Pox Iqk� DCTAccavn&N'um6er: 4�0�� i-- QPnpfliraDle) bYom: CITY OL TOWA GTT4' CITY: esEWS ImPICs 4T0 � AAAF1TFfGT01�' S"REET , TOt1A CTxY TOA 52240 phone; 379—m5F-5041 _ I7AXr , RYO—R5F-.5497 I ::f) /"*//92/ ' I J&ara • 1:frramata I- L�<t-;), -? -� (0-2 V6 L-barakeasnbk)perCa eio£Xa�yp,Chapter 6922. Nor comPlef9'erlmtnAlhistoryreeardinfoxmAtfotr,AsAllowadBylawn,kIP�Ays 6faihAwnisnt�alanainvr_fFnmShn,.anhlnm5 nP4ha keohacf: _—.._.._.__�_, __.,........_.. ._-- WahYer, Paydr rnYudgiroA (NCO. OPCrimindt , AOjW11'L$1PII1Y1r]).JCURWr y _mt;cUr1.Lr V.JdACk;xA�i°JUAEd ' NCl_Vson� Acof�' y��aseaachofthe,provid'edli ma anddatoaEbfiiitsovealeff, ' Ej No Yawa Crf>xrbaRistory.kecord food withDCk �. �a'a�C�iminaT.distpzyReCordat(aohed,bCJf'�.�,2V ��•. N 1 ))Ciiaufaals J T:_ —r_1 OC —IA1 1-1 A. AA AU -M- ACd1 Mar. 4. 2013 2:53PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00393287 MISDEMEANOR CONVICTIONS ONLY PAGE I OF 1 DATE PRINTED - 2013/03/04 DCI;00393287 NAME; COBLENTZ,TIM COBLENT2,TIMOTI[Y DBWAYNE DOB SEX RAC HGT WGT EYE HAIR Sm POB 19710726 M W 510 220 BLV BRO MED IA ADDITIONAL IDENTIFIERS CCH RECORD :rr 01 ARRESTED 19890007 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA700-1 ASSAULT CAUSING INJURY TRK#: L36SS6101 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA708-2-4 ASSAULT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L36556101 SENTENCE DISP EFF DAT FINE $100 /9891017 AN ARREST.HITHOUT DXSPOSITION 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 DCI, IN THE qjSENCR OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASF RMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVE HJECT OF YOUR INQUIRY. DIVIS OF CRIMINAL INVESTIGATION No. 5199 P. 2 t Iowa Department of Transportation O fice of Drimr Semw* { Toll Free) WO -532-1121 PO Sox 0204, ®cs Manes, to 503116-9244 515-244-9124 N% 515-239-183' CLEAR DRIVING RECORD Name: Coblentz, Timothy Dewayne DL/ID: 212CC2122 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: VfyIIGIENki Certified Abstract of Driving Record ►JYY a�A` Inquiry Date: 2/21/2013 DL/ID #: 212CC2122 (IA) Customer #: 231444 Name: Coblentz, Timothy Class: C ID Status: None Dewayne Address: 101 SUMMERHAYS Audit #: 5650624 DL Status: VAL ST Issue Date: 11/28/2011 CDL Status: None City/State: TIFFIN, IA Expiration Date: 07/26/2013 CDL Cert Status: None 523409363 Endorsements: NONE CDL Med Status: None Mailing Address: 101 SUMMERHAYS Restrictions: NONE Restriction None ST Supplement: Date of Birth: 7/26/1971 Mailing TIFFIN, IA Sex: M City/State: 523409363 History Information CLEAR DRIVING RECORD Name: Coblentz, Timothy Dewayne DL/ID: 212CC2122 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: VfyIIGIENki 2/21/2013 ►JYY a�A` D. 0. Office of Driver Services Iowa Department of T2nsporation Name: Coblentz, Timothy Dewayne DL/ID: 212CC2122