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Home My WebLink About12-144VIII r Allimi�� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 19) 3S6-5040 71Z% Fl—l' (319) 356-5497 FAX 1. Name �,wI f, 2. Mailing Address Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) (Office Use Only) 3. Telephone: Home 311'—LM-17 1 Other: 4. Prior experience in transportation of passengers: C' ur�� 1LQ�) l (C "_-w Dl ✓ 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 12159 yfS Where When Cr �& Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years?_L10_ Type of Offense Where 7. Have you been convicted of any traffic offenses in the last five years? When Where When -8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When 5. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) Vl o DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND SJAIF CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIE You must apply for an individual Department of Criminal Investigation Report (form available upon request) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) dekW i&vbadg I herebya h�( I�av�e�yeSl�o me by the Iowa Department of Transportation a valid Chauffeur's license number (`j y Gam} 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 ;�� T/ Date 7 �� ffH#H1HIH1ff 111HH11H4H*YHNH*H*4*H*HHHHif#*RYIHi'#4kYf'*f*4*'k*Yyk*}*111f1f1fl1fN1f1f ff 4f f 11fH44ffkf11fHH41Hf4HHHf1H1411f STATE OF IOWA ) COUNTY OF JOHNSON ) SybscAbed and s om to before me by Lv i Ct I `0- e O i tti On this day of 2_01.2- IJa s KELLIE K. TUTTLE I '" ` _ `"� — � � S commission Numger2; IS!N tary 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 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). Signatur&W Police Chief or designee 249 r _��„ W . )(&?A' -I/ Signature of City Clerk or designee !' 3/ - Date 7 -3i -/a. Date NOT VALID UNTIL Police Chief and City Clerk have approved and authorized taxi driver names placed on the city website at icgov.org. Taxi cab businesses are required to provide Driver Identification cards. *##f HRHH1f f 1f f 1H1H Hf f 1f f f f f 1f 111 f f t 11R 111!!1 1f f 1f f 1R,f f f 111 f f 1f 1H„HH,HHf HHHHHHf 1111!!! f 1Hf f,f f f f f f f 1Hf,f f f f lHf f 1!!.1111 #f Y k Approved application DCI report State certified driving record Website uod2te 0 mioaoc Office Use Only 09!2910 00aoIZ ARTS Page 1 of 2 Iowa Department of Transportation Office of Driver Services (Toll Free) 800-532-1125 FO Box 9204, Des Moines, IA 5030&-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 7/28/2012 DL/ID #: 059BB9825 (IA) Customer #: 1387263 Name: Maeglin, David Otto Class: D ID Status: None Address: 2038 DEERFIELD RD Audit #: 5187550 DL Status: VAL 02/14/2002 A90 Issue Date: 04/28/2011 CDL Status: None City/State: MUSCATINE, IA Expiration 12/11/2016 CDL Cert None IA 527618329 Date: Status: Type Effective End ACD Explanation Endorsements: 3 CDL Med None IA IA Status: Mailing Address: 2038 DEERFIELD RD Restrictions: Corrective Lenses Restriction None Date of Birth: 12/11/1959 Supplement: Mailing City/State: MUSCATINE, IA Sex: M 527618329 History Information Convictions Citation Date Conviction Date ACD Explanation County 3UR 02/14/2002 03/26/2002 A20 Deferred Judgment OWI 70 IA 05/12/2009 07/15/2009 592 Speed 52 IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence ACD Explanation 3UR 02/14/2002 A90 OWI Test Failure IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number ]UR 11/29/2007 411385 IA Sanctions Type Effective End ACD Explanation Occurrence ]UR IUR Revoked 02/25/2002 08/24/2002 A90 OWI Test Failure IA IA 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: http://172.29.254.55/drivers/reports/customerhistoryleertifieddrivingrecord.aspx 7/28/2012 Ju 1. 25. 20122 4:08PN1� Div of Criminal investigation No. 02/4 P. 3/h v i LJ. LU I J• I n i v I r r b I c I a b I I T V I 1 V V d b I t y 110. L e l a F. (/ STATE OF IOWA Criminal History Record Check Request Form )DCI Account Number: Ofappllcabro) To: Iowa Dlvlslon of Criminal investigation Support Operations;3ureav, V )1001- 2151;,1'h Street D os Moines, Iowa 50319 (515)125-6066 (515) 725-6080 Fax T am requesting an. Iowa Mminal Histmy Record Check on: From: CITY OFIOWA CITY CITY" CI,C Q9 OFFICE 410 E. WASHINaTONSTILFWT IOWA. CITY IOWA 62240 )Phone: 319356-5041 )Fast; 319356-5491 Last Name mandatory rirstNalne(mandatory) MCI MeNaMe roaommcndod) /bele D'AtIV& Date of Birth mando(ory) Ge)idel (mandatory) Social Security Number (meommonded) Male ®Female Waiver Difor01011on Without a signed rvoivor from the sub] act of the roquost, a completo crJminal Dist ory record may not be releasable, per Code of lows, Chapter 692.2, ,For co, mplete criminal lilstory record infol•ntation, as olloived by Inw, nlwnys obtain a waiver signature from the sub iect oftho reaawt. Waiver Release- I hereby ovo permission for tho a60v6rogllcs((ng oaicia(td conduct wi Towa odmlltat h(storytword Acckwith th-Dlvis(on otcdmina( 1mcsligalion(DCp. Any orlmioslhlstory data mnccm�nlethat alnieinodbylh=AC1nla do9allo1VedbyleW, ii P\� Waiver rt'nzzalw-e- 1 Iowa Cximinal Iiistoly Record Check Results (D CTvseonly) As of asearch ofthe provided name and date ofbJrthielealed: 11 NoIo«VaCriniinalHistoa:YRecordf'oundwMDCI AIowa Critnival Tlistoxy Record attached, DCI #E y u l7 g p DCT Received TimerJul.23,1(2012 9!48AM No.0047 G Jul.25. 2012 4:08PM Div of Criminal Investigation IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI:00491790 NAME: MASOLXNiDAVID OTTO DOE SETS RAC HGT WGT 19591211 M W 511 185 DCY 00491790 PAGE 1 OF 2 DATE PRINTED - 2012/07/25 EYE HAIR Sm POB GRN BRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD -** 01 ARRESTED 19941122 AGENCY: IA0700100 MUSCATINE PD CHARGE NO- 01 XA STATUTE IA708-2A-2B SIMPLE DOMESTIC ABUSE TRK#: 012603801 COURT DISPOSITION AGENCY: IA0700150' MUSCATINE CO DIST COURT COUNT NO- 01 IA STATUTE IA708-2A-2B SIMPLE DOMESTIC ASSAULT TRK#: 012603601 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; XA070015J MUSCATINE CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / IST OFF COURT CASE XD; 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 XA700.2A(4) DOMESTIC ABUSE 3RD TRK#: M00167401 COURT DISPOSITION DISP EFF DAT 19950127 DISP EFF DAT 20020320 20020320 20020320 20031021 No.0274 P. 4/5 Ju1.25. 2012 4:08PM Div of Criminal Investigation No.0274 P. 5/5 DCT 00491790 PAGE 2 OF 2 AGENCY: IA070015J MUSCATINE CO DIST COURT COUNT NO- 01 IA STATUTE IA700.2A(2)(B) DOMESTIC ABUSE ASSAULT WITHOUT INTENT CAUSING INJURY COURT CASE ID: 07701 AOCRO26903 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: M00167401 SENTENCE DISP EFF DAT TIME SERVED 2D 20030619 SUSPENDED JAIL 60D 20030819 JAIL 62D 20030819 FINE $250 20030819 PROBATION IBM 20030819 04 ARR88TED 20040129 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 1A STATUTE IA124,401 (5) POSE 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 1Y 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 0b' 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 INFORMATION FURNISHED. WE CANNOT CONPIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION il