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HomeMy WebLinkAbout19-065�III� ti rR.rlf�_ CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (319)356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO.� (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 Last First r , ,M 2. Address (REQUIRED) S J�43d r 3. Contact Information (REQUIRED) Email: �OSm:� S?Id a �a, /. �� +, Cell Phone: .3/9 3ZS38 �� (All written communicatioo�ent via email) 4a. Drivel's License expiration date (REQUIRED) r b. Taxicab Business Name (REQUIRED) "eller � C.A 5. Prior experience in transportation of passengers: ti"vf Wer ---i P 4c ear 4 F✓r Sir 70� N✓.rbP� Gti��� [/YF.t—r c 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense 7 1,-4 n. Where What happened to the charge? (Circle one) 5 -y a" Convicted Dismissed Deferred SuspendedeadGuil// Other 7. Have you been arrested / charged with any traffic offenses in the last five years? YP t Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspend Plead Guilty Fier .o 8. Has your driver's license or chauffeur's license been suspended or revoked in the last fi yeprsl�- /1FCa Type of offense Where n "h �M C i -o T. J /; 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, pleasorovidrt a name(s) Ar T r AKY) 04/2018 f Page 2 APPLICATION FOR TAXICAB VEHICLE DRIVER 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 that I have issued to me by the Iowa Department of Transportation a valid Driver's license number s6 hyo 77 issued on expiring on zb I understand that if I falsely answer any questions in this application, that this a pli tion may be denied. I dgre6 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 authorization to be a taxicab driver 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 W/2 9 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworrr77� to before me by i H 'tt .� _ 5 0-4 r �L. on this 2 day of A, ...1 , c V -1 � t1% fo-+ I have reviewed this application, DCI report, and the State certified driving record of this applicaand h<yre deterfr'lhed that there is no information which would indicate that the issuance would be detrimental to the safety lth,weffare cf resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). w �-- �"� o C%l - r3 z� z� � -0 in Expiration date of Driver' license ornI w Q 7 08 30 -tel q Signat 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. I W11 91 M.: SOMEONE,,, WON' Office Use Only Approved application DCI report State certified driving record Website update g - ?i o Date CleWTAXIDRNBADGEAPPL92018.end .DOC 04/2018 Aug.23.2019-.12:41 PM DCI 10WA 013h..,,�,..� ..t.., �...rCab ffAX)319338 N o, 612 3 P. 1 / 521002 a TE OF IOWA e! Criminal History Record Check Request Form „ Tot Iowa Dtvislon of Crlmtnal Investigation Support Operations )bureau, l" Flocir 211 E 7a Street Des blolaes, Iowa $0319 (615) 72&6066 (515) 7256080 Fax I am reausatin¢ an low& Criminal Mistenv R annul r- Reck rm• DC1 Account Number; 9947-F " — (ifypbaab>� From. Yellow Cab of Iowa City P.O. Boa 428 Iowa Cltyr IA. 52244 (319) 338A777 Phone: Fax: (319) 330-7302 0 LdstName tmeamual Fir6tNauad' to MiddieNametn SMfTh ci a Date ofBirth eduo Gentdet mwaa. SocWSec Nu—M d.d) I 2 �lYYate dPemaie y��' 9 3S W Br XIF fbYlftd14x: Withoot a aipted wstvar'trom the subject of the request, a complete criminal history raootd may not be releasable, por Code of Iowa, Chapter 093.2. For comoll criminal bistory record loformatiou, as allowed bylaw, always obtain a waiver nature from the subject of the ie ueat, WaiverAlTele se:ihettbygivepamtiaelapfrtheabovete mminguncwtoconductmimvaarhnloallllnorymewdohe"EhThe D(A00aurCARIal InvokVdM (DCI)• My erhnirai Wary data =00ah,g nta that is maimeUkd byiNe DO maybe reissued as allowed by iaw, waivar sigm lum 1 � t winal Msjory Record ClbcckResullts ` off.'_ .,wee tyj. o o't As of a search of tho provided name and dato o f bh th myoa�� tT�i arc m a x v4(Of �—d � No Iowa Cdpainal �Ii,4taty Rocord found with DCI Iowa Critninal FI'istnry Record attached, DC1 # 3 DO lnWa13T,Lj�,—. DCI -77 (08125/10) Received Time Aug, 16. 2019 3:50PM No. 5114 Aua.23.2019 12:41PM DCI IOWA IOWA CRIMINAL HT9TORY DCI 00543519 MISDEMEANOR CONVICTION9 ONLY PAGE 1 OF 2 DATE PRINTED - 2019/08/23 DCI:00543519 NAME: SMITH,TIM SMITH,TIMOTHY PAUL DOB $EK RAC HGT WGT EYE HAIR SKN POB 19750113 M W 602 200 BRO SRO MED IA ADDITIONAL IDENTIFIERS SC BREAST CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 19970124 AGENCY: IA0180100 CHEROKEE PD CHARGE NO- 01 IA STATUTE IA714-2-2 THEFT 2ND DEGREE TRK#% 015588501 COURT DISPOSITION AGENCY: TA018015J CHEROKEE CO DIST COURT COUNT NO- 01 IA STATUTE: IA714-2(5) THEFT STE DEGREE CHARGE CLASS% MISDEMEANOR CONVICTION TRK#: 015588501 SENTENCE DISP EFF DAT FINE S65 19970506 COURT COSTS 19970506 No.6123 P. 2/5 O 9 �1 r O O� � tt 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. This response can only include public criminal history data. Under Iowa law, most juvenile records are confidential. Confidential juvenile court records, if any, cannot be included in this response. A Signed release authorization is not sufficient to obtain this information from the Division of Criminal Investigation. In order to request the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry: http://www.iowasexo£fender.com/ . However, even though Dome information is available on this site, the actual records for juveniles may still be confidential and any confidential juvenile records cannot be provided with this record. In order to request the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD A�s.23.2019 12:41PM DCI IOWA COVBAS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No. 6123 P. 3/5 y t1 © n c-, r'� ..� C—I O 3 t' f C410WADOT wvwmiawadot.gC)y WARM I SIAMER N CUST014ER DRI:#EN Driver& IdentiNca'don sardc" PO Box 92041 Des htovws.. IAS83D8-92D4 Phone: 515,244-91241 Fax: 515r234 -IW Certified Abstract of Driving Record Inquiry Date: 7/17/2019 DL/ID 7r: 556ZZ4072 (IA) CDL Permit Class: None Customer if: 2042987 ' Class: D CDL Permit Issue None Date: Name: Smith, Timothy Paul 'Audit tt: 2488150 CDL Permit None Expiration Date: Address: 220 5 CHESTNUT ST APT 2 Issue Date! 01/2312018 CDL Permit None Endorsements: p • Expiration Date: 01/13/2026 CDL Permit None'"r Restrictions:' City/State: NORTH LteERTY,`IA Endorsements: Chauffeur 3 ID Stratus: � 523179111 "7 (�3 Mailing 220 5 CHESTNUT ST APT 2 Restrictions: Corrective Lenses DL Status: VA6 Address: Restriction Supplement: None CDL Status: NaCrAC') EL"r Mailing NORTH LIBERTY, IA CDL Permit Status: V City/Stated 523179111 LO Date of Birth: 1/13/1975 CDL Cert Status: Non® Sex: M CDL Med status: None History Information Convictions Citation Date Conviction Date ACD Explanation JU R. County ... _. 09/20/2014 �10/30/2014 ��. 592 {SPeed 'IA :Johnson Name: Smith, Timothy Paul OL/ID: 556ZZ4072 (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 accuratecopy 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: p �txr ov rppry 7/17/2019 pa%/2Anb— Driver & Identification Services Iowa Department of Transportation Name: Smith, Timothy Paul DL/ID: 5SM4072 (IA)