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Home My WebLink About14-138410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (3 19) 356-5497 FAX 1. Dame Authorization Number ILI _V3?— (Office Use Only) Y C FYI « -sU77T0i=i Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) 2. IMMling Address 3. Telephone: Hor 4. Prior experience iin transportation of passengers: 5. Have you ever been jy2e of offense d3 t I< ff When 1, 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? MA 7. Have Have you been convicted of any traffic offenses in the last five years? Type of offense RM I Wt,, 8. Has your drivers license or chauffeurs license been suspended or revoked in the last five years? N cr I 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) darWbWdrjvbsdg 03/2014 N hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number ,1 )")r r 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 ".•... �; y a .�u �� Date C ? 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. STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by ga On this } day of 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). 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. w E�r" .+;�.✓�4P."f,.w„J� .."'wP..er�r".sd°.,.�” Signature"®f City Clerk or designee .�. .�.W. _)4ap "'�te Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and 5 %11 (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update c', e&%apddvbedgeapp2014.doc 03/2014 a;AJul_ 0. 20144 9:35AM ° Div of Criminal [nvestigat on DCI I'ois�o, 3722 P:� 1/5 STATE OF IOWA To- Wow AMRS �7-041 b=MGkfA' Iowa -song A" N R pmt-B®fs --. Gua r� a. �� PBau � 9„/ ZZ a X m d �¢d maea nN a dmov the n ag ._oPehm NqUW4 empIde aflosrhaB gboaay word M%ynoe 09 P�'dm�i� d!, m aaff u �Ibwr �7.. d'anr, a2^fi�lla�H Ib � rv�rar� qm�r� n , ma �pd�oYnd �'g ��xY„ �d�vaf� aamc✓,a w �I �v' d� �� Y�� w�ai��uAbrhaw, MCIVMWrY) As of ,w a with of the providod dd a and dato ofbud h ralcd; No Town awina Hwoty Rewrd found wyh Dcz 9 Received Time Jul. 3. 2014 1ADAM No. 3546 Jul. 8. 2014 9:35AM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00628040 NON CONVICTION PAGE 1 OF I DATE PRINTED.. 2016/07/06 DC1100820848 NAME: MIDDAUGH,GABRIEL ABRAHAM DOB SEX RAC HOT WGT EYE HAIR SKN POS 19041102 M E 500 145 13RO ELK L'SR MI ADDITIONAL 1:k'YSNT,IcFT"z)p,S PHOTO AVMLARLEA Y TAT L SHLD TAT LF ARM TAT NECK TAT R SHLD TAT RE ARM CY.'I( XAC'OAAD m AGENCY: XA0520200 IOWA CITY PO CHARGE NO— 01 IA STATUTE IA321J.2(A) OPER VSEL wx INT (OWI) / IST OFF TRK#e IA003KO01 COURT DIOPOSITION AGENCY8 KA052015J JOHNSON CO DIST COURT COUNT NO— 01 IA STATUTE IA321J.2(A) OPER VSH MR TNT (OWI) / IST OFF COURT CASE ID: 06521 OWCROU2561 CHARGE CLASS: NON CONVICTION TRK#e IA003KO01 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DEFERRED JUDGEMENT $625 CIVIL PENALTY PROBATION IY SUPERVISED TO DCS DISE q.MA?F OAT 20U80521 20000521 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORI, BUREAUMAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, O IDENTIFICATION IS A PUBLIC RD BUT ONLY BE 3 E14FORCEMENT AGENCIES BY THE DCI IDENTIFICATIONIN THE ABSENCE OF FINGERPRINTS FOR POSITIVE BASED ON INFORMATION npXXSHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUaaRCT OF YOUR INQUIRY, DIVISION OF Ckiw"NAL INV`kStiGhtION ill No. 3122 P. 2/5 DOT wwwowadotgov SMART [A I .`aRMPR' I.R R CUSTOMER DRIN'EL, . , er � � a�.�.•ae w „tea �� Git/Irs TA Od"i AeTvicees Po BOX7204 d..Ir.Ycr moetln[^r% kN F 306 ?JAM PFoermy. 515-244,0124 � RGU a;ky2 1121 r FaX: 515-2W 483T bwww .NCw7as#atiNYB.CJ'av Inquiry Date: 6/27/2014 Name: Middaugh, Gabriel Abraham Address: 1024 E BURLINGTON ST City/state: IOWA CITY, IA 522403206 Mailing Addeawo 1024 E BURISNG'PON ST' Mailing City/state: IOWA CITY, 1A 522403206 4;y=m pIvntio. 4'." ConvINAWn 111.., Iii"OLeziliJUB ,.. .. GN21,fXiIna ...... Uu2ggv oaq ;G414/I',AIv/Jilts Caartii0liedl Abssk4lract of 11:611IV1111ng q' empa d DL/ID #: 769YY4850(IA) Custmmer #: 4224396 Claws D ID statue: EXP Audit 0: 8187148 OL Status: VAL Issue Date: 06/20/2014 CDL status: None expiration Date: 11/02/2018 COI. Can 6tatm5r None Illmdomem#iliac 3 CDL Med #tatua: None Igaatrictlone: NONE. Neetrlotion None Date dlBl"m 11/2J1984 seppiemant: Sam M Hilaory Information Ace IIUW.lih MIntllmm A'RD I Xnmeuumd I0911urvnmrt OW1 v Operating While Iffithadcated Teat Refunal/Tedit Failure Violation® ACID Ml+c 16':fkcY9rre; Iliuvd Rn,akcO .. WAS„A 1'20ue , ... . ,. 91:aytu nada;„M} Qbap'71,iM,+dilloA GNSNIDAIX,I2a Name: Middaugh, Gabriel Abraham DL/ID: 769YYMSO KIVU "I"awt ii lura A4CUP k.rlplmana"Gin Axa '0W"0 IlPsT l ¢aide a.ro�iumwb' ltlnm Cacclarrvenuuum: WIR.. :WR IA Ae, Pursuant to Iowa Cote §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 heid 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 auModead by the Director of the Iowa Department of Tromportagon to so certify. In witness whamof, X Inane caused my slgnaturc and the seal of the Department to be set upon this document, at Ankeny, Nowa this daps: o�� `... OwO "°I �t 6(27(2014 °°. Y �,'°""o••••� Office of drive, So'Wors Iowa Department Of Transportation Name: Middaugh, Conrid Abraham DL/ID: 769ri4850