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Home My WebLink About18-086CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 5 22 40-1 826 (319) 356-5040 (319)356-5497 FAX Last 1. Name (REQUIRED) 2. Address (REQUIRED) IDENTIFICATION NO. ( Z " 03 (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) Failure to complete the "required" information will result in denial of the application 1 ^ First 1 Middle JVIi1� 1s i -TIKO� 7 wl)lllOLW .0 N vj,JQv, e, 44 #9 'TtnjaGeM .TA S22 3. Contact Information (REQUIRED) Email: -�iw t��n f Witt 7b f �y A�oo dell Phone: (314) 3 43 -l04 6C7 (All written communication via email) 4a. Driver's License expiration date (REQUIRED) q/ I $ AO 24 y� �. b. Taxicab Business Name (REQUIRED) el�o � `` �1D 11 � (-i rJ { 5. Prior experience in transportation of passengers: I I y 2 Cil � 16X1 A C 1 qe f )h: n'%&) (A C) -N y , 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere y C5 %5� Type of offense Where When iqg� What happened to the charge? (Circle one) j .n _n a Convicted Dismissed Deferred SuspendedPlead Guilty I71he1c 7. Have you been arrested / charged with any traffic offenses in the last fiveyears? C-a� F t Type of offense Where nn 3 �' o o What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Na 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) po (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 w• APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 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). I hereby certify tha(I hays issued to me by the Iowa Dep rtme of Transportati n valid Driver's license number i �3y�C I4Uc issued on o9I t / Nexpiring on gJU 4 1 understand that if I falsely answer any questions in this application, that this application may be denied. I agree that in making this application, 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 authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of Title 5, Chapter 2, of �e City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant XAA %IV Date 1919 -VI NlNlNf4NNflflffNff!!!!llffNfNlNN444#4#ffffNllNfff 4#fflNlNlNfNNNflflfifNlfNf1N11flNlHN#fe4#lMN4 kfflNNlNiY�#4l1NNN!! STATE OF IOWA ) COUNTY OF JOHNSON ) �,ubscribed and sworn to before me by r„e'A\ on this �3y �� day of lrVCUS� ao1R State -713(yo I have reviewed this application, DCI report, and the State certified driving record of this applic*apd have de�rmined that there is no information which would indicate that the issuance would be detrimental to the safe!f� Ith�r welfaPptpf resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). <r y 1 ` , Expira tvoi icense ` w 7 Sign a of Police Chief or designee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. Approved application DCI report State certified driving record Website update 0eA?AXIDRNfl4DGEAPM2018ameMetl.DOC Office Use Only k- 'q- /K Date !4/2018 CJIDWADOT SMARTER I SIMPLER I CUSTOMER DRIVEN www•iowadot.gov Driver & Identification Servicts PO Box 9204 I DCS 116161im. IA 50986.9204 P11o(W 515.244.9124 i Fat 515.239.1837 Certified Abstract of Driving Record Inquiry Date: 8/22/2018 DL/ID #: 713XX1449 (IA) Customer #: 1833101 Class: D Name: Fuhrmelster, Timothy Audit #: 3050110 William None DL Status: Address: 1401 Marcy St Issue Date: 08/01/2018 ELG Expiration 08/18/2024 Date: City/State: Iowa City, IA 522402117 Endorsements: Chauffeur 3 Mailing 1401 Marcy St Restrictions: Corrective Lenses Address: Restriction None Mailing Iowa City, IA 522402117 Supplement: City/State: Date of 8/18/1968 Birth: Sex: M History Information CDL Permit Class: None CDL Permit Issue None Date: CDL Permit None Expiration Date: V CDL Permit None Endorsements: CDL Permit None Restrictions: ID Status: None DL Status: VAL CDL Status: None CDL Permit Status: ELG CDL Cert Status: None CDL Med Status: None Accidents - Accident Involvement indicated does NOT mean the Individual was at fault or given a citation. Accident Date JUR Case Number 02/18/2014 IIA 1787979 Name: Fuhrmelster, Timothy William DL/ID: 713XX1449 (IA) Pursuant to Iowa Code §321.10, I, Darcy Doty, Driver & Identification Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by Driver & Identification Services, that this Is a true and accurate copy of an officlal 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: 0 Name: Fuhrmelster, Timothy William DL/ID: 713XXI449 (IA) 88//222//2200188 V Driver & Identification Services Iowa Department of Transportation Aug. 2. 2018 9:22AM 07/3012018 15:19 Yellow Cab Div of Criminal Investigation r No. 8331 P. 1/4 (FAM19 338 2708 P.002/002 STATE OF IOWA, CriWinal History Record Check Request Porm Yc To: Iowa Mvision or Criminal Investigatloa Support Operations Bureau,19 Ploor 215 E,7' Street Des Maines, Iowa 8o319- (515) 725-6066 ' (515) 725-6080 Fax an DCI Aoco4t Number: _9967-F (If appllosbia) From: i'elfow Cab aPlotva Cf .e.0,. Box 428 Iowa City, IA. 52244 (319)338-9777 , Phone: . I+axt (319) 399-7902 Li, rn(1eiseTV, ofk of Birth (5e dato 'Gender In d o - SncjaLSec 1 - -- �ultuaeedad Male Mromale waiver,(nformation: Without a sighed we(ver from the subject of the request, a complote grftnlual history record may not be releasable, per Code of Iowa, Chapter 692.2. )?or complete criminal historyreeoro informafton, as allowed by late, always obtain awaiver s;anatureirnmrLncntt..Gra Waiver Release:I hereby give Potraission forthcabove rec levettlgatlon (D'CI). My criminal history data kien=nl 0 that OMNI to wndua an Iowa criminal history.renud check with the Division of Criminal a;ncd by thePM may be re ly allowall by law. Oct use only) As of SearclUOf the name and date oPbjtth revealed: ❑ No Iowa Criminal Histoiy Record found with DCT r. p Iowa 'Cri'minal Mpfory J ecord aftached,'DCI # DCI initials DCI -77 (08125/10) Aug. 2. 2018 9:22AM Div of Criminal Investigation IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI:00373668 NAME: FUHRMEISTER.TIM FUHRMEISTER:TIMOTHY WILLIAM FURHMEISTER,TIM FURHMEISTER.TIMOTHY WILLIAM DOH SEX RAC HGT WGT EYE 19680818 M W 600 200 BLU ADDITIONAL IDENTIFIERS TAT L ARM TAT L CALF TAT L LEG DCI 00373688 PAGE 1 OF 2 DATE PRINTED - 2016/08/02 HAIR SKN POB BRO FAR IA CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 19880403 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA123-46 PUBLIC INTOX TRK#: L33950601 COURT DISPOSITION AGENCY: IAOS2015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA123,46 CONSUMPTION / INTOXICATION - 1978 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33958601 SENTENCE PLEAD GUILTY FINE $25 COURT COSTS $20 02 ARRESTED/TAKEN INTO CUSTODY 19900401 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA204-401-3 POSSESSION.SCHEDULE I/MARIJUANA TRK#: L33956701 -COURT-DISPOS3--T-ION--....._..... _....... _._._ AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE; IA204-401-3 POSSESS SCHEDULE I/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33958701 SENTENCE JAIL 1D CREDIT W/TIME SERVED SH 03 ARRESTED/TAKEN INTO CUSTODY 19971005 AGENCY: 1AD520200 IOWA CITY PD CHARGE 140- 01 IA STATUTE YA706-2A-2E ASSAULT/CAUSE INJURY/DOMESTIC TRK#: 037285101 D19P EFF DAT 19880418 19800410 19880418 DISP EFF DAT 19900703 19900703 No -8331 P. 2/4 Aug. 2. 2018 9:22AM Div of Criminal Investigation No -8331 P. 3/4 COURT DISPOSITION AGENCY: IA052015J COUNT NO- 01 JOHNSON CO DIST COURT IA STATUTE: IA236-2-2 DOMESTIC ASSAULT CAUSING INJURY COURT CASE ID: 06521 SRCRO45954 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 037285101 SENTENCE SUSPENDED JAIL 28D JAIL 300 FINE $250 PROBATION lY DCI 00373688 PAGE 2 OF 2 DISP EFF DAT 19960115 19980115 19980115 19980115 04 ARRESTED/TAKEN INTO CUSTODY 19981104 AGENCY: IA0520209 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA708-2A(28)(313) ASSAULT WITH INJURY/DOMESTIC/ENHANCED TRK#: 044597001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- O1 IA STATUTE: IA708-2 ASSAULT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 044597001 SENTENCE DISP EFF DAT JAIL ID 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 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. 1