HomeMy WebLinkAbout19-055CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
1. Name (REQUIRED)
2. Address (REQUIRED)
IDENTIFICATION NO. 16t --(O cS '
(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
Last
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211 S S' S,
First// Middle
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3. Contact Information (REQUIRED)Email: X' ,,lCn/M M jI0-gL�gvHg,/,cow Cell Phone:
(All written communication 9ent via email)
4a. Driver's License expiration date (REQUI
b. Taxicab Business Name (REQUIRED) rC
5. Prior experience in transportation of passengers:
Il/o2 / 202
\5
6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere?
Type of offense
Where
When
V 096y
1-7.
What happened to the charge? (Circle one)
o
Convicted Dismissed oeferred Suspended Plead �Guilty.�>:6/theP,�
7. Have you been arrested / charged with any traffic offenses in the last five years? t�Sr / -,'
Type of offense Where
What happened to the charge? (Circle one)
Convicted Dismissed Deferred
When
Suspended Plead Guilty Other
8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years?
Type of offense �1Where//� J. When
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9. Have you ever appligdd to'— an Iowa City taxi driver using a different name. If yes, please provide the name(s)
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AND
04/2018
Page 2
APPLICATION FOR TAXICAB VEHICLE DRIVER
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).
I herebycertify that 1 have issued to me by the Iowa D part ent of Transportation a lid Driver's license number
r `( Yl 11950 issued on // /3 PY expiring on / G2 26 . I understand that rf
falsely answer any questions in this application, that this a plica ion 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 1 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, of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant ' z Z�� Date
STATE OF IOWA )
COUNTY OF JOHNSON )
Su`bscrGbled an Cf
to before me by Nl mlcalKt \ AA �q�ron this � day of
and for the
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
-7,3U. 71
Signature olice Chief or designee 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 of City Clerk or designee
Office Use Only
Approved application
DCI report
State certified driving record
Website update
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SMARTER I SIMPLER I CUSTOMER DRIVER V114V4N`IOWF3I�Ek�gCMV
DAw@( a IdeWpeation Services
PO 8cx 920s I Des IlAcine& IA PiQ3C GsM
Phone" 515-244-912A I Fax 515.299-18T'
Certified Abstract of Driving Record
Inquiry Date:
7/23/2019
DL/ID #:
769YY4850(IA)
Name:
Middaugh, Malcolm
Class:
D
VAL
Gabriel Abraham
Johnson
CDL Status:
Address:
2115 3 ST APT 2
Audit #:
3383324
None
IA
Issue Date:
11/13/2018
City/State:
IOWA CITY, IA
Expiration Date:
11/02/2026
!&one
522402047
10/24/2016 D51
Supplement:
IA
C
Endorsements:
Chauffeur 3
Mailing Address:
2115 J ST APT 2
Restrictions:
NONE
Date of Birth:
11/02/1984
Mailing
IOWA CITY, IA
Sex:
M
City/State:
522402047
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History Information
Convictions
Customer #:
4224396
ACD
ID Status:
EXP
7UR
03/06/2008
DL Status:
VAL
Deferred Judgment
Johnson
CDL Status:
None
03/17/2008
109/12/2008 A98
CDL Cert Status:
None
IA
03/06/2016
CDL Med Status:
None
o
Muscatine
Restriction
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10/24/2016 D51
Supplement:
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Citation Date
Conviction Date
ACD
Exiollanation
County
7UR
03/06/2008
05/21/2008
A20
Deferred Judgment
Johnson
IA
Revoked
03/17/2008
109/12/2008 A98
OWI
IA
IA
03/06/2016
03/31/2016
S92
Speed (10 mph &
Muscatine
IA
Suspended
09/16/2016
10/24/2016 D51
under in 35-55 mph
IA
IA
zone
Operating While Intoxicated Test Refusal/Test Failure Violations
Sanctions
Type
Effective
End ACD
Explanation
Occurrence
JUR
)UR
Revoked
03/17/2008
109/12/2008 A98
OWI Test Failure
IA
IA
Suspended
09/16/2016
10/24/2016 D51
Non -Payment of
IA
IA
Child Su ort
Name: Middaugh, Malcolm Gabriel Abraham DL/ID: 769YY4850
Pursuant to Iowa Code §321.10, I, Darcy Doty, Director of Driver & Identification Services, Iowa Department of Transportation,
do hereby certify that I am the custodian of the records held by Driver & Identification 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:
7/23/2019
Driver & Identification Services
Iowa Department of Transporatlon
Name: Middaugh, Malcolm Gabriel Abraham DL/ID: 769YY4850
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071J111,1.29 2019�9:19ACab DCI IOWA
O:W`193382Nw.1901 P. 1/69003
STATE OF •
Criminal : History Record 1 '
ck
Request Vorm
4a'tn.
To: Iowa Division of CrIsolnal InvesTjgatlon
Support Operatiotis Bureau, 10 Floor
215 E. 76 Street
Des Moines, Iowa 50319
(515) 725-6066
(515) 725-6080 Far
I am-requestink an Iowa Criminal Histnr -,hPrnrd f hank- nn.
.:fly
DC1Ac ufttNumber: 9967-F '
(if applicable)
From: Yellow Cab of Iowa City
P.O. Box 428
Iowa City, LA. 52244 g
(319) 338-9777 ' n
phone:
Fax: (319) 339-7302 ca T --
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Last Name ma.&s,,1y)
FiMt'NaMO, mwdeta
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gvoomrdode
Date of Birth (mandatory)
',Gender mandate
"Social-Security Ntlmbv ;,xomm=ddcdd))
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Waiver Information: Without'! signed waiver from the Subject: of the request, a complete erlmtnal history record may, not
be releasable, per Code Of Iowa, Chapter 692.2• For ociviglate criminal history -record information, u allowed by law, always
obtain a waiver signature from the subject of the r uest.
Waiver Release: 1 hereby give permission Por the show requesting official W conduct an laws criminal history r=rd cee& with the Division ofC,lminal
Investigndon (DCI'_ Any criminal hlamry data mnetnin j me that is maintained by the DCI may be re)emed aLallowc4 bylaw.
Waiver Signature;' /� „......
.
As of ��- (� a searcia: of the provided name and date
❑ No Iowa Criminal History Reoord found with DCI
*----Iowa Criminal History record attiiobed, DCI #
DCI initials CC�
DCI.77 (08125/10)
Received Time Jul, 23. 2019 9:28AM No. 1014
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Cilli F CRIMINAL INVEST
J01.29.2019 9:19AM DCI IOWA No. 1901 P. 2/6
IOWA CRIMINAL HISTORY DCI 00826549
NON CONVICTION PAGE 1 OF 2
DATE PRINTED -
2019/07/29
DCI:00826840
NAMEt MIDDAUGH,OABRIBL ABRAHAM
DOB SEX RAC HGT WGT EYE HAIR SKN POB
19041102 M B 506 145 BRO ELK LHR MI
ADDITIONAL IDENTIFIERS PHOTO AVAILABLEz Y
TAT L SHLD
TAT LF ARM
TAT NECK
TAT R SHLD
TAT RF ARM
CCH RECORD ***
01 ARRESTED/TAKEN INTO CUSTODY. 20080306
AGENCY: IA0520200 IOWA CITY PD
CHARGE NO- 01 IA STATUTE IA321J.2(A)
OPER VKH WH INT (OWI) / IST OFF
TRK#: lAO03KO01
COURT DISPOSITION
AGENCY: IA052015J JOHNSON CO DISTCOURT
COUNT NO- 01 IA STATUTE: IA321J.2(A)
OPER VEH WH INT (OWI) / 1ST OFF
COURT CASE ID: 06521 OWCROO2561
CHARGE CLASS: NON CONVICTION
TRK#: 1A0031KO01 -
DRUNK DRIVING SCHOOL
SUBSTANCE ABUSE EVALUATION
SENTENCE
DEFERRED JUDGEMENT $625 CIVIL PENALTY
PROBATION lY '
UNSUPERVISED TO DCS
DISCHARGED FROM
DEFERRED JUDGEMENT
DISP EFF DAT
20080521
20080521
20090213
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
enforcement agencies by the DCI.
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J41.29.2019 9:19AM DCI IOWA
No.1901 P. 3/6
Thie response can only include public criminal history data, Under Iowa law,
most juvenile records are. confidential. Confidential juvenile court records,
if any, cannot be included in this response. A signed release authorization
is not sufficient to obtain this information from the Division of Criminal
Investigation. In order to request the release of confidential juvenile
records, if any, an application must be filed pursuant to Iowa Code section
232.197(18).
Additionally, criminal history data concerning convictions for certain
juvenile sex offenses can be found on the Iowa Sex Offender Registry:
http://www.iowasexotfender.com/ . However, even though some information is
available on this site, the actual records for juveniles may still be
confidential and any confidential juvenile records'cannot be provided with
this record. In order to request the release of confidential juvenile
records, if any, an application must be filed pursuant to Iowa Code
section 232.147(18).
IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS
BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD
COVERS THE SUBJECT OF YOUR INQUIRY,
DIVISION OF CRIMXNAL INVESTIGATION
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