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TALEA WHEELER - EXP 12/2014 CITY OF YELM IOFFICIAL USE ONLY 1 / 'ov Me A'‘. i 105 YeIm Ave. W. FFEEc By 35.00 gr '1 YeIm, WA 98597 Comm Dev.Dept. 4 (360) 458-8437 OFFICE Bldg Dept. (360) 458-4348 FAX Insp.Date www.ci.yelm.wa.us Lic.No. YELM APPLICATION FOR WASHINGTON BUSINESS LICENSE HO aq Upon receipt of the license application and $35.0q payment, the City of Yelm will conduct an inspection of the premises for building and fire code con\for,ance. Upon approval from the Yelm Building Department of said premises, the City Clerk's Office will process the application and mail license to applicant at address listed below. Application is hereby made for a Business License for the City of YeIm pNEW� BUSINESS' E NAME CHANGE/MAILING ADDRESS CHANGE ONLY 1 DATE I,4-II )O�`"1Ih(�(,�(, £1,/, BUSINESS NAME nip, (` l�'� J/V it NATURE OF BUSINESS `TG�{A , (r ,wk.e 1 (\t\ick. p/Act m BUSINESS LOCATION ADDRESS 4P`41 l']-C-OrGe--- 12._lJ' �C `t-C[vv\, iJill-qg«17 MAILING ADDRESS �L Oetrr <(� IN ov Iv-- 1-" , �"'� �c3p M-G )--1 EMAIL ADDRESS CtOk " "at7 6l G`I ,c` I 1 ANTICIPATED OPENING DATE 411/-)-Do-f DAYS & HOURS OF OPERATION O 1 d4--- ti /S OWNER(S) 1(A VI( 6 Tki w l/lekl e,r, Address )- "C 16 3 � l 6l'\ h V`� kid. 0� j•Ihf 9 O) TELEPHONE ?4b--)0, 333 Cit 3(- ,C , e cRicti4 Zip (Business) (Ho ergency Lf 9‘,6471- CONTRACTOR'S y6471-CONTRACTOR'S REGISTRATION NO. (If applicable) THURSTON CO. HEALTH APPROVAL NO. �(-� z STATE OF WASHINGTON MASTER BUSINESS LICENSE NO. (UBI) —1_ i )-2`J Signature 1 '4 w P^"' Date __ i Page 1 of 1 Washington State Department of Revenue State Business Records Database Detail TAX REGISTRATION NO: 603197129 ACCOUNT OPENED: 04/01/2012 12:00:00 AM UBI: 603197129 ACCOUNT CLOSED: OPEN ENTITY NAME: WHEELER TALEA BUSINESS NAME: OLYMPIA CAB DISPATCH MAILING ADDRESS: BUSINESS LOCATION: 2103 HARRISON AVE NW PMB 855 2103 HARRISON AVE NW#855 OLYMPIA,WA 98502-2636 OLYMPIA,WA 98502-2636 ENTITY TYPE: SOLE PROPRIETOR RESELLER PERMIT NO: N/A PERMIT EFFECTIVE: N/A NAILS CODE: 485310 PERMIT EXPIRES: N/A NAICS DEFINITION: TAXI SERVICE(PT) FOR NON-COMMERCIAL USE ONLY 07/22/2014 4:21 PM http://dor.wa.gov/images/BRDImage.aspx?tra=bClMrPTj X+dht 1 tkg2MSDuInedJtj R3 C&... 07/22/2014 } OFFICIAL USE ONLY FORWARD TO P.D. APPLICATION FOR TAXI OR LIMOSINE FORiURE OR RENEWAL Please complete application to register with the City of Yelm.A renewnlapplication shall be made in the same manner upon submittal of the fee and other information and items required for the initial application,including photographs.(5.02.030 B) Application Fee.$35.01 PAID PROOF REC'D-Waived if applicant has established an approved license from another Thursto Count city. Proof of the paid for-hire license for the same time period and background check must be shown j • and verified.(5.0 171 C.) • Fingerprinting Fee$5.00 (5.02.030 Al) Submit photographs with application- Three recent photos must be submitted with application. (ix application,Ix police dept, lx attach to license when issued) CI' 3(�.3q4 (14-64 Driver's Name` _(��� 0610Phone number`—Tls�{'� �� ��C�I� Stare d Zlpc de / 0547 Driver's Address y, o 440 LS Mailing Address 9/03 l ' `' IU" ty-St4 vr 1anhi,ecode_ i� Valid Washington State Drivers license Number 11 - K-ir (5.02.030) Vehicle license Tag/Plate Number kiliN013 Vctri Proof of Ownership Birthdate )1'3 f l \T Must be at least 18 years old. 577.1/e f7 2 Proof of Insurance Business Name and Address b11,1 Ql lk- (5 I"Ci" ,State and Zipcode lam l �� " " r� J � ilk (1196? Mailing Address "kb 9 SCIS C t V•1L'' City,State and Zipcode D(,`� I Washington State 1181# b rt I g � 1 1)Have you been convicted of a felony,or of operating a motor vehicle while under the influence of intoxicating liquor or drugs or of being in actual physical control of a motor vehicle while under the influence of intoxicating liquor or drugs,or of reckless driving or negligent driving,or of vehicular homicide or vehicular assault,with five years preceding the date of application for a license? I�� 2)Have you been convicted of three or more moving violation during any one-year period within the five years preceding the date of the application for a license? 3)Are you at least 18 years with no physical or mental infirmity,which jeopardizes the ability to operate a for-hire vehicle.No person shall drive a for-hire vehicle,including limousines,within the City without first obtaining a license therefore from the • City. I certify my statements are tru. an. accurate.My signature authorizes the City of Yelm to verify any information including a driver's abstract. Signature )ti41 Date 1 i l I a ss , .7.7.-.E.O=- -s;.;`1}.-,.., _.4=_ ' •471y1_.4"'1 j . ;,'. T,..;Iif4 ',;i;� i�EE ! s7- tea. a e \ \i •iy , 1� �•, til +rr} i .�� i4 r 4: t Vehicle Title Application/Registration Certificate 04/08/2014 1409834120163185 AMN0687 License plate Issue date Tab no Reg expiration Value code Year Mo rag Mo gwt Power Use AMN0687 07(2_013 G200923 12/18/2014 19340 2002 12 G CAB Model year Make Series/Body Model BT Vehicle identification(VIN)/Serial no Res co Prey plate Scale wt 2002 MERC VILSW VL SV 4M2Z_V11T42DJ09574 34 ACM4879 3768 Seats Gross weight Gwt start Gwt exp Fleet Equipment number Prey Title Pre/st 1319649110 WA Brands: WA 04/08/2014 ORIG TAXI Comment: PL-F- 17-18-COLOR-SILVER-DISPLAY TAB ON BACK LICENSE PLATE ONLY-FRONT PLATE IS STILL REQUIRED. Mileage E Registered owner Legal owner ©,1, -.-, ...._.2/tp V TALEA ROSE WHFFI FR OLYMPIA CAB USA FARIWAY MOTORS INC 2103 HARRISON AVEW NW PMB 855 1500 W YELM AVE OLYMPIA WA 98502 YELM WA 98597 l I certify that the information contained hereon is accdrrate and complete. X A,�G` th, X Signe'tife of registered owns s) Signature of registered owner(s) e9 owner (s) and sworn to before this gP- day of VA . O4'1`"T . BATCH NO 2555 FILING $4.00 TBD FEE 3400 CHECK SUBAGENT $12.00 RTA EXCISE CASH LOCAL FEE USE TAX TOTAL FEES $31.00 LICENSE SRVC OTHER $15.00 GWTNWT FEE DONOR AWARENESS QUICK TITLE STATE PARKS - Validation code 03341201140980408140138016318 RE-ISSUE RPT ID: ATITPR-4 This document is ret proof of ownership. VehicleTitlePage2(R/6/12)E . i • WA INSURANCE IDENTIFICATION CARD (STATE) i COMPANY NUMBER COWANX COMMERCIAL PERSONAL Gateway Insurance Company i POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE i CAP632831401 6/10/2014 6/10/2015 i . YEAR MAKE/MODE VEHICLE IDENTIFICATION NUMBER 2002 Mercury Vil1SW 4M2ZV11T42DJ09574 i AGENCY/COMPANY ISSUING Key Insurance LLC • 5200 Southcenter Blvd, Ste 110 Tukwila WA 98188 (206)420-4270 I INSURED rTalea R Wheeler 2103 Harrison Ave. NW i Olympia WA 98502 SEE IMPORTANT NOTICE ON REVERSE SIDE I Web Address: www.keyinsure.net THIS CARD MUST BE KEPT IN THE INSURED • VEHICLE AND PRESENTED UPON DEMAN • IN CASE OF ACCIDENT: Report all accidents to your Agent/Company as soon as possible.Obtainthefollowin information • . 1.Name and address of each driver,passenger and witness 2.Name of Insurance Company and policynumberforeach vehicle involved ACORD50(2007/O °ACORD CORPORATION 19832007 AIrightsreaerved INS050(200702) � • JI� L ,�r � 7I ,4: s - .a ,mss � r--,,,_-: !L 3vfi.t / 1t ti;;tii7fi.`,l12 k v_a.Ya: a •,a.:,a .�'1. a:.a: ■. i�'r t*a a.'rI...1 ..,1 a..}a:/at!17:010; Vehicle Title Application/Registration Certificate 04/08/2014 1409834120163201 AAU2020 License plate Issue date Tab no Reg expiration Value cods Year Mo reg Mo gwt Power Use AAU2020 06/2010 G199443 10/30/2014 24315 2000 12 G CAB Model year Make Series/Body Model BT Vehicle identification(VIN)/Serial no Res co Prey plate Scale wt 2000 MERC MAR4D MG 4D 2MEFM75W9YX667049 34 66755DP 3638 Seats Gross weight Gwt start Gwt exp Fleet Equipment number Prey Title Prey st 1224120725 WA Brands: WA 06/17/2010 ORIG TAXI Comment: PL-F-COLOR-WHITE-DISPLAY TAB ON BACK UCENSE PLATE ONLY-FRONT PLATE IS STILL REQUIRED. Mileage E Registered owner Legal owner .. TALEA ROSE WHEELER OLYMPIA CAB USA (/ 2103 HARRISON AVE NW PMB 855 I\&7 OLYMPIA WA 98502 t t certify that the info tion contained hereon is accurate and complete. • xx Signat f registered owner(s) Signature of registered owner(s) Subscribed and sworn to before I C/ this e i day of i i ( . BATCH NO 2555 FILING $4.00 TBD FEE 3400 CHECK SUBAGENT $12.00 RTA EXCISE CASH LOCAL FEE USE TAX TOTAL FEES $31.00 LICENSE SRVC OTHER $15.00 GWTNWT FEE DONOR AWARENESS QUICK TITLE STATE PARKS Validation code 03341201140980408140140016320 RE-ISSUE RPT ID: ATITPR-4 This document is not proof of ownership. VehideTPage2(R/6/12)E WA INSURANCE IDENTIFICATION CARD (STATE) COMPANY NUMBER COMPAN I X I COMMERCIAL I I PERSONAL Gateway Insurance Company POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE 0632831401 6/10/2014 6/10/2015 YEAR MAKE/MODE VEHICLE IDENTIFICATION NUMBER 2000 Mercury Marquis 2MERM75W9TX667049 AGENCY/COMPANY ISSUING Key Insurance LLC 5200 Southcenter Blvd, Ste 110 Tukwila WA 98188 (206)420-4270 INSURED rTalea R Wheeler 2103 Harrison Ave. NW LOlympia WA 98502 SEE IMPORTANT NOTICE ON REVERSE SIDE . Web Address: www.keyinsure.net THIS CARD MUST BE KEPT IN THE INSURED VEHICLE AND PRESENTED UPON DEMAN IN CASE OF ACCIDENT: Report all accidents to your Agent/Company as soon as possible.Obtain the followin information 1.Name and address of each driver,passenger and witness 2.Name of Insurance Company and policy number for each vehicleinvolved ACORD50(2007/0 o ACORD C4TION 1963-2007 ARTight3,userved INS050(200702) 1111. S'GTE State of Washington UBI # , ,, % Business Licensing Service ( 1 3 " xl PO Box 9034 aov Olympia 034 Telephone: eleph ne:1-800-451-7985 For Hire Addendum This addendum form may only be submitted as an attachment to the Business License Application. Owner name Firm/trade name For Hire permit: Please have this form completed and signed by your local jurisdiction authority, which is the city your business is physically located in.To obtain contact information for your local jurisdiction, please visit mrsc.org/cityprofiles/citylist.aspx. Each For Hire vehicle certificate is $55.00. If you have NOT paid a For Hire Licensing fee to your local jurisdiction, you must send an additional $110.00 with this addendum for a state For Hire permit. Local Jurisdiction Authority o This certifies that the above-named for hire operator is approved to transport passengers for hire under provisions of local laws enacted for that purpose. ❑ This local jurisdiction partners with the Business Licensing Service and requires the for hire operator to have a City business license prior to commencing operations in this local jurisdiction. ❑ This local jurisdiction does not regulate for hire operators. IEA This local jurisdiction does not regulate for hire operators that are outside the city limits. ❑ This local jurisdiction does not recognize this business as a for hire. 1 City Official comments: • 1 it5 o %'Cte/M At e/r��r-dose cliiiiq eh * Ak Qo 6u5m urs i'l%uirt/-� D6t i z 4v1 G 1/127' 66iwiss /-/eemtti brrf' �J trG are A p,re.I 4 orb/ 4/ �� �i i / friVAI--.6r,$.zi /i ( Rc). l 7/ /i$ Signature of furl diction authority Date yei &t, e ( 40)cal jurisdiction/cityTitle of office Telephone number ( b94's '- M4 For tax assistance or to request this document in an alternate format,please call 1-800-647-7706.Teletype(TTY)users may use the Washington Relay Service by calling 711. BLS-700-200 (09/24/13) WATCH Profile Management- Washington State Patrol Page 1 of 4 Tuesday,July 22, 2014 ilii i 7-7 u• WASHINGTON ACCESS TO CRIMINAL HISTORY Web Search Transcript Washington State Patrol Identification and Criminal History Section P.O. Box 42633 Olympia, Washington 98504-2633 Telephone (360) 534-2000 This report was generated from a transaction run on 07/22/2014 at 16:23 Conviction Criminal History RCW 10.97.050(1) Pursuant to the purpose of inquiry, A possible match was found in the Washington State Criminal History Repository based on the descriptors provided: WHEELER,TALEA DOB 05/02/1972 SEX F RAC U PUR V WASHINGTON STATE CRIMINAL HISTORY RECORD FOR SID/WA19514083 WASHINGTON STATE PATROL IDENTIFICATION AND CRIMINAL HISTORY SECTION P.O. BOX 42633 OLYMPIA, WASHINGTON 98504-2633 ******************************************************************************* CRIMINAL HISTORY INFORMATION AS OF 07/22/2014 ******************************************************************************* NOTICE THE FOLLOWING TRANSCRIPT OF RECORD IS FURNISHED FOR OFFICIAL USE ONLY. SECONDARY DISSEMINATION OF THIS CRIMINAL HISTORY RECORD INFORMATION IS PROHIBITED UNLESS IN COMPLIANCE WITH THE WASHINGTON STATE CRIMINAL RECORDS PRIVACY ACT, CHAPTER 10.97 RCW. POSITIVE IDENTIFICATION CAN ONLY BE BASED UPON FINGERPRINT COMPARISON. BECAUSE ADDITIONS OR DELETIONS MAY BE MADE AT ANY TIME, A NEW COPY SHOULD BE REQUESTED FOR SUBSEQUENT USE. WHEN EXPLANATION OF A CHARGE OR DISPOSITION IS NEEDED, COMMUNICATE DIRECTLY WITH THE AGENCY THAT SUPPLIED THE INFORMATION TO THE WASHINGTON STATE PATROL. THIS CONVICTION RECORD INCLUDES INFORMATION FOR WHICH A PERSON IS CURRENTLY BEING PROCESSED BY THE CRIMINAL JUSTICE SYSTEM. ******************************************************************************* MASTER INFORMATION ******************************************************************************* NAME: WHEELER,TALEA ROSE DOB: 05/02/1972 https://fortress.wa.gov/wsp/watch/Inbox?rsPage=detail&CVIndex=0 07/22/2014 WATCH Profile Management-Washington State Patrol Page 2 of 4 SID NUMBER: WA19514083 DOC NUMBER: ******************************************************************************* PERSON INFORMATION ******************************************************************************* SEX RACE HEIGHT WEIGHT EYES HAIR PLACE OF BIRTH CITIZENSHIP F W 505 240 GRN BRO WA US OTHER NAMES USED OTHER DATES OF SOC SEC MISC NUMBER BIRTH USED NUMBER CONVICTION AND/OR ADVERSE FINDING SUMMARY ******************************************************************************* 0 FELONY(S) DISPOSITION DATE 0 GROSS MISDEMEANOR(S) 1 MISDEMEANOR(S) DRIVE W/LICENSE SUSP OR REVOKED-3 01/03/2005 1 CLASSIFICATION(S) UNKNOWN CIVIL OFFENSE 04/13/1999 ******************************************************************************* **** NO KNOWN DOC SUMMARY INFORMATION **** ******************************************************************************* ******************************************************************************* CRIMINAL HISTORY INFORMATION ******************************************************************************* THE ARRESTS LISTED MAY HAVE BEEN BASED ON PROBABLE CAUSE AT THE TIME OF ARREST OR ON A WARRANT. PROBABLE CAUSE ARRESTS MAY OR MAY NOT RESULT IN THE FILING OF CHARGES. CONTACT THE ARRESTING AGENCY FOR INFORMATION ON THE FORMAL CHARGES AND/OR DISPOSITIONS. AN ARREST IS NOT A CONVICTION OR FINDING OF GUILT. ARREST 2 DATE OF ARREST: 02/24/2005 NAME USED: WHEELER,TALEA ROSE CONTRIBUTING AGENCY: WA0310400 LYNNWOOD POLICE DEPARTMENT LOCAL ID: 57500 PCN: 532679753 TCN: WA3104000100019311 ARREST OFFENSES I DISPOSITION CONTRIBUTOR OR RESPONSIBLE AGENCY: WA031071J LYNNWOOD MUNICIPAL COURT COURT CASE NO: C00033100 STATUS: GUILTY 0763300 DRIVE W/LICENSE SUSP OR REVOKED-3 RCW: 46.20.342(1) (C) MISDEMEANOR https://fortress.wa.gov/wsp/watch/Inbox?rsPage=detail&CVIndex=0 07/22/2014 WATCH Profile Management- Washington State Patrol Page 3 of 4 I STATUS DATE: 01/03/2005 I SENTENCE: JAIL: 90 DS, JAIL SUS. : 88 DS I FINE: $1000.00, FINE SUS. : I $500.00 ARREST 1 DATE OF ARREST: 03/02/1999 NAME USED: WHEELER,TALEA ROSE CONTRIBUTING AGENCY: WA0080100 KELSO POLICE DEPARTMENT LOCAL ID: 66801 PCN: N/A TCN: N/A ARREST OFFENSES I DISPOSITION I CONTRIBUTOR OR RESPONSIBLE AGENCY: ( WA008013J COWLITZ COUNTY DISTRICT I COURT I COURT CASE NO: C05182KE I STATUS: GUILTY 09990 CIVIL OFFENSE I CLASS UNKNOWN I STATUS DATE: 04/13/1999 I COMMENT: NVOL 2 I SENTENCE: SENT. DESC. : I CHG 01: FINE-190.00 1 ******************************************************************************* STATE DEPARTMENT OF CORRECTIONS ******************************************************************************* NO KNOWN CUSTODY HISTORY INFORMATION ******************************************************************************* NO KNOWN SEX/KIDNAPPING OFFENDER REGISTRATIONS ******************************************************************************* ******************************************************************************* NO KNOWN APPLICANT DETAILS ******************************************************************************* ******************************************************************************* NO KNOWN MONITORED POPULATION REGISTRATION TRACKING INFORMATION ******************************************************************************* ******************************************************************************* GLOSSARY OF TERMS IS AVAILABLE IN THE CRIMINAL JUSTICE TRAINING MANUAL (CJTM) LOCATED AT http://www.wsp.wa.gov/crime/crimhist.htm ******************************************************************************* RESOURCES ******************************************************************************* ADMINISTRATIVE OFFICE OF THE COURTS (AOC) WWW.COURTS.WA.GOV WSP CHRU CRIMHIS@WSP.WA.GOV OR (360) 534-2000 https://fortress.wa.gov/wsp/watch/Inbox?rsPage=detail&CVIndex=0 07/22/2014 WATCH Profile Management- Washington State Patrol Page 4 of 4 WSP CRIMINAL HISTORY & FINGERPRINT TRAINING WWW.WSP.WA.GOV/_SECURED/IDENT/RESOURCE.HTM DEPARTMENT OF CORRECTIONS (DOC) WWW.DOC.WA.GOV WSP SOR UNIT (360) 534-2000 WSP CRIME LAB CODIS (206) 262-6020 RCW HTTP://APPS.LEG.WA.GOV/RCW/ LEGISLATION HTTP://APPS.LEG.WA.GOV END OF RECORD • • https://fortress.wa.gov/wsp/watch/Inbox?rsPage=detail&CVlndex=0 07/22/2014 iz,, . 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