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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
Name (REQUIRED)
IDENTIFICATION NO. C — O7 4
(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
2. Address (REQUIRED)1I�- WCSU\it
3. Contact Information (REQUIRED) Email: 1'f
(All wri
4a. Chauffeur's License expiration date (REQUIRED)
b. Taxicab Business Name (REQUIRED) 1, 11"
5. Prior experience in transportation of passengers
• (*. Cell Phone:
email)
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere?
Type of offense
b
Where
When
C_
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended lead Guilty ;)Other
Have you been arrested / charged with any traffic offenses in the last five years? S
TVDe of offense
145
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?
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)
08 -
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,upo(a; request).
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)
t�
0212015
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
I herebyFertify that I have issued to me by the Iowa Departpenj of Transportation a valid Chauffeur's license number
S �4 II4LL issued on oz expiring on 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 mpI yees of the City of Iowa City, Iowa, in their discretion, to examine any and all records and
documents relating to this anon, and I further agree that, if authorization to be a taxicab driver is granted, to comply at all
times with all of the prov' ' ns f Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applic Date 4LLL
STATE OF IOWA )
COUNTY OF JOHNSON )
S bscribed�aand sworn to before me b \\y<:_ 3
y h� n < �� on this day of
u t �
Notary blit in and for the State of low}Its
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 es A'zoI Zo1q
— jd
Signatur�of Police Chief or designee
c')5bCor Loo
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.
SIgn�City Clerk or designee
Office Use Only
Approved application
DCI report
State certified driving record
Website update
,5/ //�
ate
ClerkrrAXIDRNBADGEAPPL92014.m.nded. DOC 03/2015
C
AO Iowa department of Transportation
Office of Driver Services (Toil Freeb ODO-532-1121
PO 131W9204, Iles AALa m, K5Lt O&9204 515-244-9124
FAX -615,2391837
Convictions
Citation DateConviction
Certified Abstract of Driving Record
ACD
Inquiry Date:
4/29/2016
DL/ID #:
554XX1146 (IA)
Customer #:
1332238
Name:
Megeff, Ryan David
Class:
D
ID Status:
None
Address:
2715 WAYNE AVE
Audit #:
8322783
DL Status:
VAL
Issue Date;
08/05/2014
CDL Status:
None
City/State:
IOWA CITY, IA
Expiration Date:
03/20/2019
CDL Cert Status:
None
522402528
Endorsements:
3
CDL Med Status:
None
Mailing Address:
2715 WAYNE AVE
Restrictions:
Corrective Lenses
Restriction
None
Supplement:
Date of Birth:
3/20/1979
Mailing
IOWA CITY, IA
Sex:
M
City/State:
522402528
History Information
Convictions
Citation DateConviction
Date
ACD
Ex lanation
Count
UR
11/19/2011
12/12/2011
172
Fail to Have Vehicle
Under Control
Johnson
JIA
f9
Accidents - Accident involvement indicated does NOT mean the individual was at
fault or given a citation.
Accident Date Case Number JUR
11/19/2011 659314
IA
01/24/2012 669867 IIA
Name: Megeff, Ryan David DL/ID: 554XX1146
Pursuant to Iowa Code @321.10, I, Melissa Spiegel, 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.
�a
In witness whereof, I have caused my signature and the seal of the Department to be set upon this diiwment;:a't Ankeny; Iowa
this date; - —
P, 7
4/29/2016
IOWA
{r
*ii Office of Driver Services
Iowa Department of Transporation
Name: Megeff, Ryan David DL/ID: 554XX1146
oaMay, 2 2016412.:18PMcabDiv of Criminal Investigation (FAx)3193382N0 3295 P.r1,302�o02
y!} ;.•r,STATE OF IOWA
Criminal History
Requesia
Tot lows Division or Criminal investigation i
Support Operatlons Bureau, l" Floor
215 B. 7'4 Street
Des Molnes, Iowa 5031P
(515)725.6066
(515) 125-6080 Fax
T em rennadina an Tnw. Crin,N.1 Ale...... 0....J
DCI Account Number: 9967-F
(((epplleabla)
From: 'Yellow Cab of Iowa City
P.O. Box 428
Iowa City, IA. $2244
(319) 338-9777
]?hone•
Fax, (319) 339-7302
Dast Nnmo (menallory)
xlraE Name manaa,o
Middle Name (re maeded
Ckv-1
�
Dato of BI (menduory)
Gendor (mandatory)
'Social•Se url Number recommended)
_ 3 I �� .
Mala OFemale —7 7 • ��' ��`�(,t
Walvar rftformaflon: Without a signed waiver from the subject of the regpest, a complete criminal history record may not,
hE role t.: Ible, par Code of Iowa, Chapter 692.1. For ilomnlotg criminal history record Information, as allowed by law, always
obtain a wolyer slan4tUre from lite subject of the request.
WaIV*f jl¢i¢aSY.; [ lcrzhy give pumisslon (or I
lnvutlaellon (DC(t. AAyoriminol hlslory dam oone
e req astlng otttolel to conduct en Iowa arlminal hlatoryreoocd eheok with U a uivlelnn orCrlminel
np m t tMt malmalnod by lite DCI may be relmad u allowed by law.
Walyer signafu et
I x
As of
Iowa Criminal History Record Check Results
6 a search of 1he provided name and date of birth revealed;
Lxl, No Iowa Criminal History Record found wlth DCI
3 Iowa Criminal History Record attached, DCI 9
DCI initials
DCI -77 (08/25110)
Received Time Apr.29. 2016 12:49PM No, 3414
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