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Home My WebLink About15-294j r CITY OF IOWA CITY 410 Last Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 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 1. Name(REQUIRED) j.)AW I I ) E 2. Address (REQUIRED) _ 9�03 ``rCJ I_J 1: EJZ r- 3. Contact Information (REQUIRED) Email: (All written omn- 4a. Chauffeur's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: _ ll=L0 I 40e, q114,5r, Win sent vi !42 ' C 0"hII Phone3147- q-?'/ - )'+ % Y —/=0 Li4 G S/N (-Q 2 607 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? 4f-5 Type of offense Where -9— :t �— `qt; T actt� ab / / q a 2 f When I sca re ^til / m u fr iL� 1549n iyb'K / 03 M wS c yvve What happened to the charge? (Circle one) 1 " ' Convicted Dismissed Deferred Suspended Plead Guilty Other 7 Have you been arrested / charged with any traffic offenses in the last five years? IV 0 Type of offense Where When 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? _ /-)a Type of offense Where When �9 C� rfv ( J s 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provlde'theAhame(�) No DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE-Ctl IPIED f- DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF ROIEW You must apply for an individual Department of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0212015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby_celtify #{ have issue�o me by the Iowa Department of Transportation valid Chauffeur's license number (J 4 j,� ``11 SS issued on exoirina on /a-/// W _ 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. 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, oftheCity Code. (Needs to be signed in front of a Notary Public) Signature of Applicant pfd /1-1 Date STATE OF IOWA ) COUNTY OF JOHNSON ) to cribed and -sworn to before me by )i (Yicle �i A on this TVC� day of Public in and for the State of Iowa 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 Chauffeur's license / 2n&zz (,-, r Signature of olic C ief d3t designee I 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. Sfgnat f City Clerk or designee bate =' Office Use Only 4: N Approved application DCI report State certified driving record Website update cie�MDRivenocenPFLe2oiaamended,DOC 03/2015 State of Iowa Division of Criminal Investigation 215 E. 7"' Street Des Moines, Iowa 50319 Phone: 515/725-6066 Fax: 515/725-6080 Iowa Criminal History Record Check Walk -In Rennest Your name: Lit1/_/ Andress: r -E2F/SLP Ci /State/Zi Phone #: ( - Reauestina an Iowa criminal histnry record shack n,r Fill in all shaded areas. Last Name .aveul,k, onnndato y) First Names, lmer Nowh e(mandaA,iq) Middle Name s., Ev,dNnn,brer oco nmendndl 11144- 6L(,A Date of Birth voormterto(m.damry, Gender vesper° (n,andiwn)) Social Security Number (,xm mended) � �f KMale ❑Female LIOZ-66 -(q30 / Waiver Signature Fdam(If the requcstis on yourself pleasesip Ifthc request is on someone clsc. write N/A.) Results IR J USE t,"L, As of 1 ZA `a,� �� , a name and date of birth check revealed: ❑ No record found •; � tccord attached DCT# LAq Q o ..QQ l rn DO initials _ � w 70h U - Receipt Number of requests 1 x $15.00 per last name = Total amount $ \ ��' W7 Method of payment: s?c cash money order check # W';= Mastercard or Visa Cardholder's name DCI initials �� Credit Card # DCI -83 (09/09/10; Revised 10/1/10; form reviewed 08/11/14) Exp. Date (I pt 4 dig sem-, CO IOWA CRIMINAL HISTORY DCI 00491790 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - DCI :00491790 2015/12/02 NAME: MAEGLIN,DAVID OTTO DOB SEX RAC HGT WGT EYE HAIR SKN PDB 19591211 M W 511 185 GRN BRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED 19941122 AGENCY: IA0700100 MUSCATINE PD CHARGE NO- 01 IA STATUTE IA708-2A-2B SIMPLE DOMESTIC ABUSE TRK#: 012603801 20020320-7 _ COURT DISPOSITION 20020320 AGENCY: IA070015J MUSCATINE CO DIST COURT COUNT NO- 01 IA STATUTE: IA708-2A-2B SIMPLE DOMESTIC ASSAULT TRK#: 012603001 co 3 SENTENCE DEFERRED JUDGEMENT 6M 02 ARRESTED 20020214 AGENCY: IA0700000 MUSCATINE CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWI IST TRK#: 061312001 COURT DISPOSITION AGENCY: IA070015J MUSCATINE CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER VEH WH INT (OWI) / IST OFF COURT CASE ID: 07701 OWCRO23499 CHARGE CLASS: NON CONVICTION TRK#: 061312001 DRUNK DRIVING SCHOOL LICENSE REVOKED SUBSTANCE ABUSE EVALUATION SENTENCE DEFERRED JUDGEMENT PROBATION 18M COMMUNITY SERVICE 40H DISCHARGED FROM DEFERRED JUDGEMENT 03 ARRESTED 20030615 AGENCY: IA0700000 MUSCATINE CO SO CHARGE NO- 01 IA STATUTE IA708.2A(4) DOMESTIC ABUSE 3RD TRK#: M00167401 COURT DISPOSITION AGENCY: IA070015J MUSCATINE CO DIST COURT DISP EFF DAT 19950127 DISP EFF DAT N 20020320 u 20020320-7 _ v' 20020320 20031021 may; co 3 N DCI 00491790 PAGE 2 OF 2 COUNT NO- 01 IA STATUTE: IA708.2A(2)(B) DOMESTIC ABUSE ASSAULT WITHOUT INTENT CAUSING INJURY COURT CASE ID: 07701 AGCR026983 nr CHARGE CLASS: MISDEMEANOR CONVICTION ENFORCEMENT AGENCIES BY THE DCI. TRK#: M00167401 SENTENCE DISP EFF DAT TIME SERVED 2D 20030619 SUSPENDED JAIL 60D 20030819 JAIL 62D 20030619 FINE $250 20030819 PROBATION 18M 20030819 04 ARRESTED 20040129 lY 20040514 AGENCY; IA0S20200 IOWA CITY PD 20040514 CHARGE NO- 01 IA STATUTE IA124.401 (5) POSS CONTROL SUBSTANCE I TRK#: 101070401 COURT DISPOSITION AGENCY: IA0S2015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 SRCR067657 nr CHARGE CLASS: MISDEMEANOR CONVICTION ENFORCEMENT AGENCIES BY THE DCI. TRK#: 101070401 LICENSE REVOKED SUBSTANCE ABUSE EVALUATION IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD S$ -a SENTENCE b< DISP EFF DAT SUSPENDED JAIL 30D 20040514 JAIL 30D 20040514 FINE $250 20040514 PROBATION lY 20040514 COMMUNITY SERVICE 25H 20040514 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW nr ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD S$ -a ry b< BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECO COVERS THE SUBJECT OF YOUR INQUIRY. `" O' " DIVISION OF CRIMINAL INVESTIGATION W' r •.. fV Iowa Department of Transportation Office C4 Urr t, Drvitcs 41 cill f fil bw 532 1121 PO Got 9204, UCS Molrie5, th W31)6 11204 151S 244' 124 FAM 5112231 193( Certified Abstract of Driving Record Inquiry Date: 12/1/2015 DL/ID #: 059BB9825(IA) Customer #: 1387263 Name: Maeglin, David Otto Class: D ID Status: None Address: 2038 DEERFIELD RD Audit #: 5187550 DL Status: VAL Issue Date: 04/28/2011 CDL Status: None City/State: MUSCATINE, IA Expiration Date: 12/11/2016 CDL Cert Status: None 527618329 Endorsements: 3 CDL Med Status: None Mailing Address: 2038 DEERFIELD RD Restrictions: Corrective Lenses Restriction None Supplement: Date of Birth: 12/11/1959 Mailing MUSCATINE, IA Sex: M City/State: 527618329 History Information CLEAR DRIVING RECORD Name: Maeglin, David Otto DL/ID: 059BB9825 Pursuant to Iowa Code §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 held 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 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: _�` (jt `4yl 12/1/2015 6 I .66 C cn .� cp Office of Driver Services —•� Iowa Department of Transporatioo - Name: Maeglin, David Otto DL/ID: 059BB9825