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Home My WebLink About20-043� r 1 it""IIIaNJtp �� CITY OF IOWA CITY 410 East Washington Street Iowa City. lutea 52240- 1826 13 19) 356-5040 1319) 3S6-5497 FAX 1. Name(REQUIRED) 2. Address (REQUIRED) IDENTIFICATION NO. 20 — 0 U 3 (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 WH rme,1'5 1 7AO - �tl First Middle I tMOYly will 3. Contact Information (REQUIRED) Email: +i YN T✓(y r'4tGt $ Ir! ya 4 ie. Cd Cell Phone: 319 -313- G GG O (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) g/ 14 /; L' b. Taxicab Business Name (REQUIRED) y C II of Cab OF ?,d1I Ell 1 5. Prior experience in transportation of passengers: S yeetr5 1 wX i ckri�Vef— It) TOt✓u c 1 i -y 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When What happened to the charge? (Circle one) > Convicted Dismissed Deferred Suspended < Plead Guilty Other _ 7. Have you been arrested/ charged with any traffic offenses in the last five years? Tyne of offense Where W jjen i What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other B. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Ny 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) 1/ (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 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 yrllfy that I have Issued to me by the Iowa Department of Transportation a valid Drivers license number 71 XX 14 V-1 Issued on 1 I It expiring on gI1O N . I understand that if I falsely answer any questions in this application, that this application may 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 authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of Tide 5, Chaver 2, of the City Code. (Needs to be signed In front of a Notary Public) Signature of Applicant w _ Date hO 9 0 �J CD C7 YNttHNMMiYttMMMtttNNitMttMMMttMMMattMlrRtlatttltMNMtMttMMFtitMM}tlllMtfat,IMttMttYlY�tMttMtttwttMax STATE OF IOWA ) =� COUNTY OF JOHNSON ) =" Subscribed and swam to before me by on this j day of Notary Public In and for the State of Iowa Moat+xxxt�xxxxrMMtMMMMww»w�awMtMMttMwtxMt+a txMxMwxwxtrtex+M,�MxMMMatrwMtMMMwwMMMMx.txe I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there Is no Information which would Indicate that the Issuance would be detrimental to the safety, health or welfare of resi. dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Driver's license ifs % 2-H Signature of once hlef or designee 01- Z.6 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. _gglytS Date Approved application Office Use only DCI report State certified driving record Webelte update Cm,WTAXIDRIVMGEAPLO2a18am ndnd.DOC 04120111 Iw__.____ .I.__ -_-.--. ..uV %I PAN IVJ L. .JVJIVVJ d, nk STATE OF IOWA Criminal History Record Check Request Form Iowa DhIelon of Criminal Invesuption Support Opermdooc $mean, in Floor 215 M r Street We Moines, Iowa 50319 (515) 725-6066 (515)725.6060 Fax I mel r duestine an Iowe Cnrninal Hiatffry Reoord Fo' rt -m iS- f' DCI Account Number: 5.� results m: Addrww ]J�4�_ Pboae Fox ,` M 4D it, / I v,11111,q K1 b1m.e OFemale 4S5--76- a+%if19, A9 of ( , a search of the provided name -and date of birth revealed: ❑ No Iowa Criminal History Record found with DCI Iowa Criminal FUstory accord attached) DCI DCI initiate a • imina : s :•history rew DCI -77 (updated 06-26-201B)�111 111,.,,,`hr natio Received Time Oct. 5. 2020 1:22PM No. 1811 to z o ua Q z � o � a LL O 0 Page I oft IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI:00373688 NAME: FUHRMEISTER,TIN FUHRNEISTER,TINOTHY WILLIAM PURHNEISTER, TIN PURHNEISTSR,TIMOTHY WILLIAM DOB SER RAC HGT WGT EYE 19680818 M W 600 200 BLU ADDITIONAL IDRNTIPIERS TAT L ARM TAT L CALF TAT L LEG CCH RECORD •*+ DCT 00373688 PAGE 1 OF 3 DATE PRINTED - 2020/10/07 HAIR SKN POB BRO FAR IA 02 ARRESTED/TAKEN INTO CUSTODY 19580403 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA123-46 PUBLIC INTOE TRK#: L33958601 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA123.46 CONSUMPTION / INTOXICATION - 1978 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33950601 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 POSSESSTON.SCNEDULB I/MARIJUANA TRK#: L33958701 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA204-401-3 POSSESS SCEEDULB I/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L33958701 SLENTENCE JAIL LD CREDIT W/TIME SERVED 8H 03 ARRESTED/TAKEN INTO CUSTODY 19971005 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- OL IA STATUTE IA708-2A-2B ASSAULT/CAUSE INJURY/DOMESTIC TRK#: 037285101 DISP EEE DAT 19880415 19880418 (j O 19850918 VI h) DISP EFF DAT 19900103 19900703 I COURT 161SPOSITION AGFNCI: IA052015J CO*T No- of J014NSON CO DIST COURT IA STATUTE: IA236-2-2 DOMESTIC ASSAULT CAVSINS INJURY q COURT CASE ID: 06521 SRCR045754 CHARGE CLASS! MISDEMEANOR CONVICTION TRK#'; 037285101 SENTENCE SUSPENDED JAIL 26D JAIL 30D FINE $250 PROBATION ly DCI 00372689 PAGE 2 OF.- 4 DISP EFF DAT 19980115 19990115 19980115 19980115 04 ARRBSTED/TAKEN INTO CUSTODY 19981104 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 TA STATUTE IA708-2A(2B)(3B) ASSAULT WITH INJURY/DONSSTIC/ENHANCED TRIC#, 044597001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708-2 ASSAULT CHARGE CLASS! MISDEMEANOR CONVICTION TRU: 044597001 SENTENCE DISP EFF DAT JAIL 1D 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. 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, it any, an application must be filed pursuant to Iowa Code section 232.147(18). Additionally, Criminal history data concerning conviction for certain juvenile sex offenses can be found on the Iowa Sex offender Registry: http://Www.lowasaxoffender.com/ . However, even though some 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). r.s cs O C7 E5 Cn N IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IE BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION oS Crin�ieal?ry i� A r 'p Iowa criminal r history results: ati r-, c_> (VJ CDn� n —: — 1M T `o c.n ry oS Crin�ieal?ry i� A r 'p Iowa criminal r history results: ati 04141 DOT SMARTER I SIMPLER I CUSTOMER DRIVEN aaaA °wadoi~gov orkw & wMttrleanon smim PO Box 92M I Des Moines. IA 5030frM Phone 515244-9124 1 Fax 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 10/7/2020 DL/ID #: 713XX3449(IA) Customer #: 1833101 Name: Fuhrmeister Class: D ID Status: None Timothy Wiliam Address: 1401 Marcy St Audit #: 3050110 DL Status: VAL Issue Date: 08/01/2018 CDL Status: None City/State: Iowa City, IA Expiration Date: 08/18/2024 CDL Cert Status: None 522402117 Mailing Address: 1401 Marcy St Mailing Iowa City, IA City/State: 522402117 Endorsements: Chauffeur 3 Restrictions: Corrective Lenses Date of Birth: 08/18/1968 Sex: M History Information CLEAR DRIVING RECORD Name: Fuhrmeister, Timothy William DL/ID: 713XX1449 CDL Med Status: None Restriction None Supplement: ti C� G 4 �n r Pursuant to Iowa Code §321.10, I, Darcy Doty, Director of 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 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: Fuhrmeister, Timothy William DL/ID: 713XX1449 10/7/2020 Driver & Identification Services Iowa Department of Transporation