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HomeMy WebLinkAbout17-005A IDENTIFICATION NO. J-7 l 1 (Office Use Only) let APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA C ITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) 410 East Washington Street Iowa City, Iowa S2240-1826 Failure to complete the "required" information will result in denial of the application (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) ��' �l!�/~�/Cx'C/ /��� MA.6ca-f71 / zzi( 3. Contact Information (REQUIRED) Email: j/y1,cel it & 04446/l', c?-vt r Cell Phone: 5IQ (All written communidation sent via email) 4a. Driver's License expiration date (REQUIRED) 12,111 / 7,C z 1 b. Taxicab Business Name (REQUIRED) Bu:, -7-eiL 7A- -Y-? C.4B 5. Prior experience in transportation of passengers: nr? A 60 9 v 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Tvoe of offense Where When G� l ntichhC i 7- Z4FCZ What happened to the charge? (Circle one) Convicted ` Dismissed Deferred Suspended Plead Guilty Other C_oJ 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where When �ac'i�✓e �ir� r�l� h�HcCu��,�c ` x`` t— What happened to the char cle 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? NU Type of offense Where When -' 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pnI (ide the names) 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 upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certi ,y j veis��e0.10 me by the Iowa D a ent of Transportati n valid Driver's license number CJS 7 issued an on S uf%x `I 7piring on 1116111 "1 I understand that if I falsely answer any questions in this application, that this application may be denied. I agrefe 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 /hapter 2, o'f-the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant �'�'�/ m Date f H!H!H!HlHlH111fH1f fllf f!lHflf 11!!11!!lfIHITTfIHflHH1Hf 11flH1HH1f11f HHHTTHHITIfIfHlH1H11HH!lfl Hf H1H1I1HYfH1t!/ff t STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by r.. _ zvl —1 1NENDV S. ' I ti on this / ( day of 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 Driver's license ! 2 I // /La� J 5k Signature of Police Chief or designee /1l f � -7 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. Signature o ity Clerl or desi nee Date N C� Gle W %IDRN6>DCEA PL9201"e dW DOG 07/2016 Office Use Only t ; CD S Approved application r� DCI report ro State certified driving record rn Website update Gle W %IDRN6>DCEA PL9201"e dW DOG 07/2016 Iowa Department of Transportation Otka d Dino t .wakes i t -Al I reo180 W2-112/ PO Hof 920II. Des Nltat08, IA't7306 32t)1 I AX 515 23"8t11i7i Convictions Citation Date Certified Abstract of Driving Record ACD Inquiry Date: 1/11/2017 DL/ID #: 059BB9825(IA) Customer #: 1387263 Name: Maeglin, David Otto Class: D ID Status: None Address: 2038 DEERFIELD RD Audit #: 1300701 DL Status: VAL Issue Date: 09/15/2016 CDL Status: None City/State: MUSCATINE, IA Expiration Date: 12/11/2021 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 Convictions Citation Date Conviction Date ACD I Explanation iCountv IUR 01/21/2016 02/04/2016 1401 Fal l to Yield Right of Wa Muscatine IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date I Case Number 3UR 01/21/2016 903133 IA Name: Maeglin, David Otto DL/ID: 059889825 Pursuant to Iowa Code 4321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Department of Trjnsportation, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this is a true anew ccurate copy of an official record currently in the custody of said Office, and that I have been authorized by the Dlre6'�the4ava Depa ent 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, aOAnkeg,` BI wa this dater tV T r 1 D. 0. T, Name: Maeglln, David Otto DL/ID: 059BB9825 1/11/2017 Office of Driver Services Iowa Department of Transporation D L:7 tom- l Y 4 5 �' m State of Iowa Division of Criminal Investigation 215 E. 7" Street Des Moines, Iowa 50319 Phone: 515/725-6066 Fax: 515/725-6050 Iowa Criminal History Record Check WAlk_In Rnnnrct Your name: A�/© A 6llt Address: '.p (� City/State/Zip: K ne (F j Phone#: i�1 - Reciuestine an Iowa criminal history record check on: Fill in all shaded areas. Last Name Apellido (mandatory) First Name Primer Nombre (mandatary) Middle Name Segundo Nombre (recommended) /414--6G-ir1 Z)/+O (b © 7--�'v Date of Birth Fecha Naclmiento (mandatory) Gender Genera (mandatory) Social Security Numberq(recommended) j% 1 /l ( C �g5c( ? Male ❑ Female Lal� I—vQ�0'—1/lit Waiver Signature Firma (If the uest is on yourself, please sign. If the request is on someone else, write N/A.) D All Results DO USE ONLY As of 1 i fo 11L , a name and date of birth check revealed: y ❑ No record found E'Record attached DCI # .. it DCI initials W Receipt Number of requests x $15.00 per last name = Total amount $ ) S 00 Method of payment: ��cash money order Cardholder's name DCI initials Credit Card # DCI -83 (09/09/10; Revised 10/1/10; form reviewed 08/11/14) r~, check # G MplerCar4r Visa (Last digits) ro _ N Exp. Date T IOWA CRIMINAL HISTORY DCI 00491790 !' MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED- DCI:00491790 2016/12/16 NAME: MAEGLIN,DAVID OTTO DOB SEX RAC HGT WGT EYE HAIR SKN POB 19591211 M W 511 185 GRN BRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** O1 ARRESTED 19941122 AGENCY: IA0700100 MUSCATINE PD CHARGE NO- 01 IA STATUTE IA708-2A-2B SIMPLE DOMESTIC ABUSE TRK#: 012603801 COURT DISPOSITION AGENCY: IA070015J 14USCATINE CO DIST COURT COUNT NO- 01 IA STATUTE: IA708-2A-2B SIMPLE DOMESTIC ASSAULT TRK#: 012603801 SENTENCE DEFERRED JUDGEMENT 6M 02 ARRESTED 20020214 AGENCY: IA0700000 14USCATINE 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) / 1ST OFF COURT CASE ID: 07701 OWCR023499 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 14USCATINE 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 20020320 20020320 20020320 20031021 Q CD C-) J Fri C� ti N .F N m 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 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: M00167401 SENTENCE DISP EFF DAT TIME SERVED 2D 20030819 SUSPENDED JAIL 60D 20030819 JAIL 62D 20030819 FINE $250 20030819 PROBATION 18M 20030819 04 ARRESTED 20040129 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124.401 (5) POSS CONTROL SUBSTANCE I TRK#: 101070401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 SRCR067657 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101070401 LICENSE REVOKED SUBSTANCE ABUSE EVALUATION SENTENCE 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 o 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{ BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECO,:, . COVERS THE SUBJECT OF YOUR INQUIRY. _eff -O DIVISION OF CRIMINAL INVESTIGATION � rJ CX/ N