HomeMy WebLinkAbout13-0371 — t
CITY OF IOWA CITY
410 East Washington Street
Iowa City. Iowa 52240-1826
(319) 3S6-5040
(319) 356-5497 FAX
First
1. Name "-MOA
Authorization Number 13 _3Q
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
Last
2. Mailing Address ZZo 5 0hrsJtN,4- S1. Not{ -l., L.be/A
3. Telephone: Home Other:
4. Prior experience in transportation of passengers: y Px % �>f CA s (",6 Do v«
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offers Where When
iN 5`1 Qce�.ee Clwo& a,nw4 444 1901o's
} rN SI-'" J7ur t/ii+n �u,�A1, Z �p (9Ro's
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? Iry
Type of Offense
Where When
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense
Where When
/owv. (yl
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? NO
Type of offense
Where When
9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provide the name(s)
NLI>
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)
derMfl idnvbadg 09/2012
I hereby certi that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
O7 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, 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 rovisions 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 )
and sworn to before me byOn this day 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).
r
Signatur Ott
lio hief or designee
-2 r- /2
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']Cltir� A%i1.ti
Signatute of City Clerk or designee
Taxi cab businesses are required to provide Driver Identification cards.
C2 -c)5" -/_ 3
Date
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Office Use Only
Approved application
DCI report
State certified driving record
Website update
de"idrivbadge pp201o.doc 09/2012
Iowa Department of Transportation
AW Office of Drivel Services (Toll Free) 800.532.1121
Pb Box 9201, Us Molnm,1A 5030&9201 515-244-9124
FAX:615-289--I837
Certified Abstract of Driving Record
Inquiry Date:
2/25/2013
DL/ID #:
556ZZ4072 (IA)
Customer #:
2042987
Name:
Smith, Timothy Paul
Class:
D
ID Status:
None
Address:
220 S CHESTNUT
Audit #:
6615605
DL Status:
VAL
ST APT 2
Issue Date:
01/15/2013
LDL Status:
None
City/State:
NORTH LIBERTY, IA
Expiration Date:
01/13/2018
CDL Cert Status:
None
523179111
Endorsements:
3
CDL Med Status:
None
Mailing Address:
220 S CHESTNUT
Restrictions:
Corrective Lenses
Restriction
None
ST APT 2
Supplement:
Date of Birth:
1/13/1975
Mailing
NORTH LIBERTY, IA
Sex:
M
City/State:
523179111
History Information
Convictions
Citation Date
I Conviction Date
ACD
I Explanation
lCountv
JUR
110/12/2012
111/13/2012
S92
Seed
52
IA
Name: Smith, Timothy Paul DL/ID: 556ZZ4072
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: Smith, Timothy Paul DL/ID: 556ZZ4072
2/25/2013
i
Office of Driver Services
Iowa Department of Transporation
beb.21, 2013 2:05PM Div of Criminal Investigation No.4126 P. 1
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Iowa CrimimglChockReaylo
aoeAroh offbgOvidedname and date ofbi11Iudwakd: ;
:
(� �1'o Tows G�mJttaX 7�iatoxykiecord found w1Ch bCi � � ' • -::f ; • ,
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Yom G%uninaZ9leforyRecord attached,pGi#
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Feb.21. 2013 2:06PM Div of Criminal Investigation
No. 4126 P. 2
IOWA CRIMINAL HISTORY DCI 005435/9
MISDEMEANOR CONVICTIONS ONLY
PAGE 1 OF 1
DATE PRINTED -
DCI :00543519 2013/02/21
NAME: SMITH,TIM
SMITH,TIHOTHY 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 ARREST$D 19970124
AGENCY: IA0180100 CHEROKEE PD
CHARGE NO- 01 IA STATUTE IA714-2-2
THEFT 2ND DEGREE
TRK#: 015588501
COURT DISPOSITION
AGENCY: IA018015,T CHEROKEE CO DIST COURT
COUNT NO- 01 IA STATUTE IA914-2(5)
THEFT STH DEGREE
CHARGE CLASS: MISDEMEANOR CONVICTION
TRK#: 015586501
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 NON -LAW
ENFORCEMENT AGENCIES BY THE DCI.
IN THSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS
BASED INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD
COVER THE SUBJECT OF YOUR INQUIRY.
DIVISION OF CRIMINAL INVESTIGATION
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