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Home My WebLink About16-053.�IIIl�ftp cccccra aMP��4l CITY OF 1i CITY 4 10 East Washington Strret lowz City, Iowa 52240-1826 (3191 356-504D (3 19) 356-5497 FAX IDENTIFICATION NO. `Z to— I (Office Use OiT) )P II L1bW Cc,1 � — �ow— elly APPLICATION FOR TAXICAB 1 MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between S a -m, to 3 p.m., Monday - Friday) Failtae to romplete the�tltrecy" ini'onnatron wilt r-eszrh irr deni2t7 of The auuticaiiolt First Iddle n" Last 1. Name (RFOUIRLE) i i � >Cl r ) I•t' 2, Address lREOUIRED) 02E1 t7urli�� S�7icor �i 'Y, ��10 3. Contact Information (REQUIRED) Email:- �' -J1— , a rce,n Cell Phone: _?I 3i 3 535 y { 511 written ..ommunicatior ent via email) 4a. Chauffeur's License expiration date (RECUIRFD) r b. Taxicab Business Name (REQUIRED• 5. Prior experience in transportation of passengers: 6, Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? P4— Type T e of offense Where When ru is IkA x «a',a�, t ` -JA CL,� What happened to the charge? jCircle one) Corvicte Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested I charged with any traffic offenses in the last five years? Tyne 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' �Tl Type cf offense Where When 9. Have you ever applied to bean l�:n using a different name? If yes, please provide the name(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD Mt)St ryl.z) NY THIS APPLICATION FOR POLICE CHIEF REVIEW You must apply to,, 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 certify tha� /I have issued to me by the Iowa Department of Transportation yy vaJd Chauffeurs license number �6 ri Y7 y S5 C issued on 4 Zo expiring on _(1/AZ-/Z.otfi . I understand that if I falsely answer any questions in this application, that this appl canon 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 [Imes with all cf the provisions of Title 5, Chapter 2, of the City Code. (Needs to he signed in front of a Notary Public) Signature of Appl:cart �` �� it �z�r Date i**htty};Rk%#*#*#w4###k*Rkxk%xf;xY+hxxxwRx#*%}x*##**a*xaRai}x*y##"*xY*%t;;fiRt.!*R####xxxxxRxt%%%xx##y,F#ivk#iF*###n###xxhx#k#*x4xx%#}kk*#%RH*#;#ik STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed an �swom to before me by ('-c..� rLJ rA'M rQri u on this day of 1 A I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined the - 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 lova City (Tide 5, Chapter 2, City Code). Expiration date of Chauffeur's license t L 20I!z Signature of P ice Chief or designee Wzs1l!�;_ 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. ?f.zl_k I _ei_� Signature of City Cleric or designee Office Use Approved application DCI report State certified driving record Website update R z tall Fav az Inf Sill LIDhAPXIDRFMA QLAPPLKYAs erded00C 03f2015 4J1U%iu*k DOT SMARTER I Slant 6 I OUSTOWA VFP,1H www.fowadOt,gov Inquiry Date: 7/22/2015 Name: M ddaugh, Gabriel Abraham Address: 1024 E BURLINGTON 5T City/ State; IOWA CITU, IA 522403206 Mailing Address: 1024 E BURLINGTON ST Mailing City/State: IOWA CITU, IA 522403206 Convictions OFFICE of Da leer Services PO BGf 9204 'Dee Moines. IA 50306-9204 el:ono: 51t-244-9124 J 805-532-11121 1 Fax: 515235.1837 WAV la'sadot.gov Certified Abstract of Driving Record DL/ID #: 769YY4850 (IA) Customer #; 4224396 Class: D ID Status: EXP Audit #: 8137148 DL Status: VAL Issue Date: 06/20/2014 CDL Status: None Expiration Date: 11,'02/2018 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Restrictions: NONE Restriction None Date of Mirth: 11/2/1984 supplement: Sex: M History Information Citation Date Conviction Data ACD Explanation County JUR 03106/2608 05/21/2008 A20 Deferred Judgment OWI Johnson IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence ACD Explanation JUR 33106/2008 A98 OWI Test Failure IA sanctions I ype Effective End Revoked 03/17/2008-09/12;2068 Suspended 02/10/2012 08/02/2012 Name: Middaugh, Gabriel Abraham DL/ID: 769YY4850 ACO Expiana tion A96 'OWI Test Failure D51 Ncn-Payment of Child Su Occurrence JUR JUR IAIA sort.. _.. IA :IA PurSuarit to Iowa Code §321.10, 1, Kin Snook, Director of Odice of Driver 5ervices, Iowa Department of Transportation, de 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 rurrently In the custody of said office, arc that I have teen auLhurized by the D'.rectQr of the low, Department of Transportation to so Certify. In wltness whereof, I have caused my signature and the seal of Lhe Department to be set upon this documert, at Ankeny, Iowa this date. Name: Mlddaugh, Gabriel Ahraham DL/ID: 769YY4850 k4''rk 7/22/2015 b ..' IOWA 'trey r Omcc of Driver Services Iowa Department of Transportation Name: Mlddaugh, Gabriel Ahraham DL/ID: 769YY4850 07iJul_14, 2)1591122AM U Div of CrlTinal Intesfigafion No. 0877 F. DCr Tow,. I;,;,� STATE OF IOWA Criminal History Record Check Request Form ';.. To: lows DMaloa of Cr Woal Iavettiption Support Operadoar 6oreav, To Floor 213 w 70 strut Der Melaes,Iawa 50310 (SRO) 735.4066 (516) 725.4 Fax f , nvrnontira no tnwa CYeminal itlarnm Rt rd r±hwnk..a I3CI Account Number. g�� (It e) From: yVtMdS Tkxf 5}rrc�a ar. otic ft Sa)`io Phoael ,( 314) 35Y- Mq' Far:. 311 Mf M,A&r t, MIA W1 Name aware First Name ( Middle Name /l --t Date ofBirfh Geader Socia nH Nnmb , ff/o2f19$4 1 tale OFamaio $� ' `��" Z287 WalVer lr{Jbrnrakax; WMoo a atFaed waWer bom the mbleet of the requeD, a complete cdminal bYmry Tsrord may sol benlmghlq per Code of Iowa, CNpter 697.2. For gUagkk Wlnlnal htetory record Infurmaooto,m allowed bylaw, olfesy'l b bl AMANToWULULS ftip the subJM or the Maefil. WaiVarRef@ads:IhwebyelwtvrmraafofeeabMmgeA31etlkWmWWuawlowsM, lhhMO'Wa cbe wrhueDiVWmarerhnbal InreVlpdaa (DCO AaYrruntaea bawry � ca,asnCae an aw b e+aaatNea by mr DCl mey b ralewed 4 dlamd N' Irw, Oboe Sigxalrme- A-ofI I i a f ) T a search of the provided name and date ofbirth revoaledc 0 No Iowa Criminal History Record found with DCI Iowa Criminal Hi" Record artaohcd, DCI # q DCI initials ^T-- Received Time Jaf 10. 2015 9:23AM No. 2738 . (Dq Yw mlrj - cn --t r ur Ju 1. 14. 2015 II'22AM Civ o CilmlflaI Invesfigatiun IOWA CRIMINAL HISTORY DCI 00B28B40 NON CONVICTION PAGE 1 OF I DATE PRINTED- DCT:0082B84R 2015/09/13 NAME; XIDDAUGN,0ARRIBL ABRAHAM DOD SEX. RAC HGT WOT HYE HAIR, SKN PDA 19841IO2 M E 500 145 BRO RLK Lum 1.1I ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT L SHLD TAT LF ARM TAT NECK TAT R SHLD TAT RF ARM CCH RECORD +•� 01 ARR98TED 20060306 AGENCY; TA0520200 IOWA CITY PD CHARGE NO. 01 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / LOT OFF TRK#+ 1AO03XOUI COURT DISP09TTION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: TA321J.2(A) OPER VBH WE INT (OWI) / IST OFF COURT CASE ID; 06521 OWCRCB2561 CRAROE CLA55, NON CONVICTION TRK#: IA003XO01 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT $625 CIVIL PENALTY 2DO80521 PRORATION lY 20000521 UNSUPERVISED TO DCS DISCHAROED FROM 20090213 DEFERRED JUDGEMENT AN ARREST WITHOUT DISPCSITION 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. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFDRMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INOUIRY. DIVISION OF CRIMINAL INVESTIGATION No. 0377 P. 2/2