HomeMy WebLinkAbout14-038 Authorization Number 1L/— ( _
a — 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
rst !Addle Last
1. Name I i Ana {-(n ((��% rn 1--k
2. Mailing Address Z?,c�� 5 C_ 5S--3. Telephone: Home NJ/0 Other: 3 1c) -3 2 5- 3
4. Prior experience in transportation of passengers: Z ( 5 c, 5 CA c b 015-1✓r,{ ' /. w, C;
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Vey
Type of offenseL / r Where When
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6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? f v 5
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? fes
Type of offense Where When
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8. Has your d iver'slicense or chauffeur's license been suspended or revoked in the last five years' 0
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).
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
clerkRaxidrivbadg 03/2013
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I herebycertify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
5 6. 2 '/o ? 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 provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public)
Signature of Applicant .� 4 Date z/Z S/i y
STATE OF IOWA
COUNTY OF JOHNSON )
bscribed and sworn to before me by \ o k-v•\y Q c,AA _S rn . On this day of
DoI�I
\„Q
'NQitryublic in and for the State of Iowa
7(3 H-I
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).
•
Signat e of Poli I�ief 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.
Signat .e of City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width) and 5 1/2"
(height)and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
cledJtaxidrivbadQeapp2010.doc 03/2013
C31t " ADOT
SMARTER I SIMPLER I CUSTOMER DRIVEN WWW'iC11Nad t.gtlif
Office of Driver Services
PO Box 9204 I Des Moines,IA 50306-9204
Phone:515-244-91241800-532-1121 I Fax:515-239-1837
www.iowadot.gov
Certified Abstract of Driving Record
Inquiry Date: 2/25/2014 DL/ID#: 556ZZ4072 (IA) Customer#: 2042987
Name: Smith,Timothy Paul Class: D ID Status: None
Address: 220 S CHESTNUT ST APT 2 Audit#: 6615605 DL Status: VAL
Issue Date: 01/15/2013 CDL 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 ST APT 2 Restrictions: Corrective Lenses Restriction None
Date of Birth: 1/13/1975 Supplement:
Mailing City/State: NORTH LIBERTY, IA Sex: M
523179111
History Information
Convictions
Citation Date Conviction Date ACD Explanation County JUR
10/12/2012 11/13/2012 S92 Speed Johnson IA
07/13/2013 09/10/2013 S92 Speed (10 mph&under in 35-55 mph zone) Johnson IA
09/20/2013 10/29/2013 M14 Fail to Obey Traffic Sign/Signal Johnson 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:
,4
,o�pe`1[N*lf.7`id."j2/25/2014
5g? X;)
eeterciA
of Driver
� Q==$ IoowaeDepartme tervicesof nsportatlon
Name: Smith,Timothy Paul DL/ID: 556ZZ4072
Feb. 20. 2014 9: 53A1A1 Div of� Criminal Invest i�gation, No. 3427, P. 2/15
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�14GLd i,F.t.::". STATE OF110 V,� ,�y::1:1,..;,,,�,�,r�r'.,.
!lkrill"
% Criminal ]H[fistolr� Record Check ;ltealluuen Foirmra '' .±
DCT Account Humber: ylip r-Q--F
(Irappllceble)
To; Iowa Division ofCriminal Xnvestigatton From: City of Iowa City
Support Operations Bureau,1"Floor City Clerk's Office
215 E.7th Street 410E,Washington Street .
Des Moines,Iowa 50319
(615)125-6066 Iowa City, IA 52240
(515)725-6000 Fax
?hone: 319-356-5041
Fax; 3193563497
•Yam requesting an Iowa Criminal HistoryRecord Cheek on:
Last Name (mandatory) _ First Name(mandatory) Middle Name(recommended)
Dml' f—f-, ADo-1-41_, C„ 1
Date of Birth(mandatory) Gender(mandatooi) So dal Security Number(recommended)
II 317 S- - Dale DEemnie 17173--- 9(n--373S`Waiver Itt orination:Without a signed waiver from tb o subjeet of the request,a complete crimine l histor/record may not
bo releasable,per Code of Iowa, Chapter 692,2.For comp)etf criminalblstory record information,as allowed bylaw,always
obtain a Waiver signaturefom the subject of the request.
Waiver Release:Iherebygtre pumisalonfor the above requesting oMiotel to couduckanIowa criminal history record checkwi h thobivhlon of Criminal
Invettrgeiron(DCI, My ruminal elslory dant conantingnio titan is merekleed by the bCl mg/be(demur as allon d bylaw,
•
IYalve,'Slgualure:
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• Kowa Criminal History][drecortCjsck Re okt6 (XI weez17)
As of G- ��i , a search of the provided name end date of birth revealed: a-_= ' cn
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Inc ,
® No Iowa.Criminal History Record found with D CI i::,�.; _o ;m
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p� � .-7.1,- -t r
,1 Iowa Criminal Ilistoq Record attached,DQ ii Oki), 1 ='''
DCI initials \141)
Received Time Feb, 18. 2014 9:45AM No. 3134
Ee„b. 20. 2014 9: 53AM Div of Criminal Investigation No. 3427 P. 3/15
IOWWA CRIMINAL HISTORY DCI 00543519
MISDEMEANOR CONVICTIONS ONLY
PAGE 1 OF 1
DATE PRINTED-
2014/02/20
DCI:00543519
NAME: SMITH,TIM
SMITH,TIMOTHY PAUL
DOB SEX RAC HGT WGT EYE HAIR SKN POB
19950113 M W 602 200 BRO BRO MED IA
ADDITIONAL IDENTIFIERS
SC ABDOM
SC BREAST
CCH RECORD ***
01 ARRESTED 19970124
AGENCY: IA0180100 CHEROKEE PD
CHARGE NO- 01 IA STATUTE IA714-2-2
THEFT 2ND DEGREE
TRK#; 015588501
COURT DISPOSITION
AGENCY; IA018015J CHEROKEE CO DIST COURT
COUNT NO- 01 IA STATUTE IA714-2(5)
' THEFT 5TH DEGREE
CHARGE CLASS, MISDEMEANOR CONVICTION
TRK#: 015588501
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 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
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