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April 5, 2012To: City Clerk Marilyn GomeauFrom: City Councilor Alan MardenRe: Agenda Item - 4110Please place the following agenda item on the upcoming 4/10/2012 CityCouncil Agenda:

Council discussion and possible reconsideration of Rule 12 Hearing ofVisitors and Rule 13 of the 2012 North Adams City Council Rules of Order.

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O ffice of the C ity C ouncilCity ofNorth Adams

10 Main Street Room 109North Adams, Massachusetts 01247

./(413) 662-3015

Dear Fellow Councilo rs ;I h ave be en a ske d by a commun ity m embe r to b rin g fo rw ard co nce rn s re gardingha nd icap pa rk in g in the c ity . S eve ra l a re as h av e b een m en tion ed a nd w an te d tos ha re th em so th es e c on ce rn s c ou ld b e b ro ug ht to th e a pp ro pria te c omm itte e.

1. 40 M ain Street - T he H oliday Inn though the address is M ain S t, the m aine ntra nc e is a cce ssed o n American L eg io n D riv e. T ho ug h h an dicap p ark in g isavailable in th e ad ja cen t p arking lo t, th e w alk is su bstan tial to ga in a cce ss to theb uild in g. Is it p ossib le to d ed ica te o ne m ete red spa ce n ear th e fro nt en tran ce o fhote l f or h andic ap park ing?

2 . L ocatio n o f h and ic ap p arking sp ace s in Steeple P laza - location to park andwalk re qu ire d to g et to ramp fo r re ta il is s ub sta ntia l.

3. Han dica p p ark in g fo r acc ess to restau ra nt c om er o f H old en a nd C enter S t. N oav ailab le h an dic ap pa rk in g at th at e nd o f p ark in g lo t.

4. E agle S t. - I am w ondering if handicap parking could be considered here aswell.T hese are a few areas of concern brought to m y attention. I thank you for youra ss is ta nc e to b rin g th e in fo rmatio n p ro vid ed to th e a pp ro pria te c omm itte e.

Respectfully,N an cy P . Bulle ttCi ty Counc ilor

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CITY OF NORTH ADAM S, MASSACH USETTSOffice of the MayorRichard J. Alcombright

March 27 ,2012#10

The Hon orable C ity C ou ncilR e: Delin qu en t p aymen tsHono rable Membe rs :S ev eral w eek s ag o C ou ncilo r M ard en th ro ug h C ou ncil req uested in fo rm atio n o nd elin qu en t tax es an d o th er m un icipal paymen ts. I h av e en clo sed fo r y ou r rev iew th reesh ee ts o utlin in g ta x, ex cise , an d water a nd sewe r a ss essmen ts a nd p aymen ts re pre se ntin gFY2007-FY2011.A s you w ill note, num bers h av e been fairly con sistent bu t h av e tren ded dow nw ard o verthe past couple of years. A dm inistrativ e O fficer C anales has done m uch of this researchan d as part o f this exercise, is exam ining n ot only fiscal trends but also policies andp ro cedure s su rro undin g c olle ctio n ef fo rts in th e C ity .M r. C anales w ill discuss som e o f the details of th e reports at th e m eetin g but because ofthe com plex ity o f th e topic, I w ould ask that this be referred to Finance C ommittee forfurther discussion no t o nly on the num bers but also on our recomm end ations forc olle ction e ff or ts going forward.

MayorRJA:ll

10 Main Street North Adams, Massachusetts 01247(413) 662-3000

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CITY OF N ORTH ADAMS, MASSACHUSETTS

Office of the MayorRichard }. Alcombright

April 2 4, 2 01 2#12The Hono ra ble C ity Counc ilR e: A ppo in tm en t to the B oard o f R egistra rsHonorab le Members :I am p lea sed to rec ommen d Marily n D eRosa fo r a pp ointm en t to th e B oa rd o f R eg istrars,to a three year term to expire on A pril 1, 2 015.M arilyn is a longtim e W ard 2 w orker and has also served as W arden. H er banking andle ga l b ac kg ro un d, a tten tion to d eta il an d h er ex perien ce a s a w ard work er m ak e h er v erywell s uite d to s erv e.I r espectfu lly r eque st con firmat ion o f th is appoin tment.Respect ful ly Submitted,4;r?-MayorRJA:II

10 Main Street North Adams, Massachusetts 01247(413) 662-3000

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C ITY O F NOR TH ADAMS , MAS SA CHUS ET TSOffice of the MayorRichard J . Alcombright

April 2 4, 20 12#13

T he H on orab le C ity C ou ncilR e: A pp oin tm ent to the R ede velo pm ent A uth orityHonorab le Members :I am plea sed to rec ommend K yle H anlon fo r re-ap po intm en t to th e R ede ve lo pm en tA uthority to a four year term to expire JWle I, 2 016 .K yle is has been a great m em ber of the R edevelopm ent A uthority and he continues top rov id e sign ifica nt comm itm en t to th is b oa rd an d th is C ity .I r es pectf ull y r eque st con firmat ion o f t hi s appointmen t.Respect fu lly Submi tt ed ,

MayorRJA:lI

10 Main Street North Adams, Massachusetts 01247(413) 662-3000

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C IT Y O F NOR TH ADAMS, MASSACHUSETT SOffice of the Mayor

Richard J. AlcombrightApril 2 4, 2 01 2

#1 4T he H ono rab le C ity C oun cilR e: M cC ann R egion al A greem en tHono rable Membe rs :A t the last m ee tin g, Imenti oned tha t Iwou ld be b ring ing to C oun cil the new McC ann T echn ical S cho olR egion al A greem en t. T his d ocume nt w as en do rse d by the D istrict E xp ansion Plan nin g C omm ittee a ndapproved by their School C ommittee on A pril 5 th In that regard, I am enclosing the A greem ent as w ell asS up erin te nd en t B ro sn an 's le tte r to me re ga rd in g th is matte r.The new Agreem ent has been put in place to allow the T ow ns of C heshire and L anesboro to join the D istrict. Inad ditio n, th e A greem ent h as b een a pp ro ved by the M assac huse tts D ep artm ent o f E lem entary an d S eco nd aryE duca tio n (DESE) and affects th e C ity in tw o way s:

1. W ith this A greem ent, w e should see a slight reduction in our capital assessm ent as tw o additionalc ommun ities w ill sh are in tho se c osts.

2. This A greem ent and per D ESE will require the C ity to have 5 elected m em bers on the M cCann SchoolCommittee. As you know, we now have 4 elected and 1 appointed from the N orth A dam s SchoolC omm ittee. T he impo rtant co nsid eration is th at w e main tain ou r leve l o f m embersh ip o n th e C omm itteeat 5.

A dd ition ally, th e C ity S olic ito r ha s rev iew ed th e d oc umen t and fou nd n o issu es.The Agreem ent has to be approved by all 7 membe r munic ip al iti es and I w ould ask that C ouncil m ove and voteto app rove th e new D istric t A greem ent as p re se nte d. Su perin te nde nt B rosn an w ill b e a t th e m eetin g to an sw erany ques tions yo u may h av e.Sincerely,

MayorRJA:1l 10 Main Street North Adams, Massachusetts 01247

(413) 662-3000

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Northern BerkshireVocational Regional School District70 HODGESCROSSROAD - NORTHADAMS, MA 01247

TEL.(413) 663-5383 - FAX (413) 664-9424www.mccanntech.org

JAMES J. BROSNANS U P E R I N T E N D E N Tj b ro s n a n @ m c c a n n t e ch . o rg

April 5,2012Mayor R icha rd Alcombr ightC ity of N orth A dam s10 Ma in S tr ee tNo rth Adams , Mass achuse tt s 01247Y/~K.

D e a r ~mbright,I h av e e nc lo se d a c op y o f th e p ro po sed amen dmen t N orth ern B erk sh ir e V oc atio na l R eg io nalS ch oo l D istrict A gre em en t w hich w as a pp ro ved b y th e sch oo l comm ittee ton ig ht, April S, 2012, at its

r eg ularly sc he du led meetin g. T his p ro pose d amen dment w as ap pro ve d b y th e Massa ch usetts D ep ar tm ento f E leme nta ry an d S eco nd ar y E du catio n o n Mar ch 2 8, 2 01 2 a nd e nd or se d b y t he d is tr ic t e xp an sio np la nn in g comm ittee o n Marc h 29 th

We are m ost proud that our orig ina l 1958 ag reem en t w as th e first r eg io na l v oc ati on al a gr eement i nthe C ommonw ealth and have the confidence that our docum ent w ill once again serve as a m odel for all ofthe current 26 reg io nal v ocatio nal sch oo l d istricts. We were awar ded a C ommun ity In no vatio n C ha lle ng eG ra nt whi ch will cover the costs of review by your legal counsel. Please forw ard that nam e and contactin fo rm atio n to m e at yo ur e arliest co nv en ie nce so th at Imay p ass o n to o ur d istric t leg al c ou nse l, A ttor neyPhil ip Grandchamp. Iw ould like to m eet w ith you and any committees as you m ay deem appropriate toreview the proposed am endm ent prior to a v ote at y ou r city co un cil m ee tin g.

I w ill c on tin ue to u pda te yo u o n th is issu e a nd w e ap pre ciate th e co ntin ued stro ng communitysupport w e receive from you. If you have any questions or require any additional inform ation please do nothesitate to contact m e at ibrosnan@mccanntech.org or 413-663-5383.

Very t ru ly y ou rs ,

S i ! B R O S N A N.Superintendent

encl.c f: G . C an ales

W.DiamondP. Gig lio tt iJ. HockridgeG. R ive rs

A D A M SC L A R K S B U R GF L O R I D A

. M O N R O EN O RT H A D AM SS A V O YW I L L I A M S T O W N

http://www.mccanntech.org/mailto:jbrosnan@mccanntech.orgmailto:ibrosnan@mccanntech.orgmailto:ibrosnan@mccanntech.orgmailto:jbrosnan@mccanntech.orghttp://www.mccanntech.org/

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Northern BerkshireVocational RegionalSchool District

McCann Technical School

Regional Agreement2012

Accepted 04/05/2012

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Page 1

PREAMBLEThe original Northern Berkshire Vocational Regional School District was formed in 1958 by the towns of Adams,Clarksburg, Florida, Monroe, Savoy, WilIiamstown, and the city of North Adams pursuant to the provisions ofM.G.L. c. 71, l6A-161 and M.G.L. c.74, l-37F and CH 518, the Acts of 1958.Pursuant to the provisions of Section VII Amendments and Section vm Admission of Additional Towns to theDistrict of the Northern Berkshire Vocational Regional School District, the towns of Adams, Clarksburg, Florida,Monroe, Savoy, Williamstown, and the city of North Adams; hereby referred to as the current membermunicipalities; for good and substantial reasons consistent with the terms of the said Regional School District andthe laws of the Commonwealth of Massachusetts together with the towns of Cheshire and Lanesborough agree asfollows:

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Page 2

Town Population Population Number Proportion. Total2 0 1 0 Factor Votes Votes per Votes

MemberAdams 8,485 21.46% 3 votes 71.53 214.59Cheshire 3,235 8.18% 1 vote 81.82 81.82Clarksburg 1,702 4.30% 1 vote 43.05 43.05Florida 752 1.90% 1 vote 19.02 19.02Lanesborough 3,091 7.82% 1 vote 78.17 78.17Monroe 121 0.31% 1 vote 3.06 3.06North Adams 13,708 34.67% 5 votes 69.34 346.69Savoy 692 1.75% I vote 17.50 17.50Williamstown 7,754 19.61% 2 votes 98.05 196.10TOTAL 39,540 100.00% 16 votes 1000

B. Members1 . Composition of the Committee: The Committee will be composed of sixteen (16)

members.2. Allocation and Weight of Votes: The Committee will cast votes based upon the

Proportional Votes per Member method as detailed inSection II A,subsection 1, 2, and 3.

3. Election of Members: Each elected member must reside in the town or city, which she orhe represents. Each elected member must be elected consistent with the process for theelection of town or city officials in said town and will be elected to open seats during theannual election or a special election in said municipality. The term of each electedmember from a town will begin on the day after his or her election and after being swornin by the respective town clerk, and the term of each elected member from the city ofNorth Adams will begin on January l" following the election and after being sworn in bythe city clerk.

4. A member who has not otherwise vacated his or her seat will continue to serve until hisor her successor is elected and sworn.5. Each elected member will serve a three year term, with terms for each municipality

staggered. For the purpose of staggering terms, the terms of the current Committee willcontinue with the new member municipalities electing their representative to serve a termof three years.

6. Election to the Committee shall be guided by the options detailed in M.G.L. c. 71, 14E.C. Vacancies

If a vacancy occurs among the members elected by a member town under Section IT(A), theselectboard of the town involved shall appoint a member to serve until the next annual town election,at which annual election a successor shall be elected to serve for the balance of the unexpired term, ifany. Ifa vacancy occurs among the members elected by the city of North Adams under Section II (A),the city council shall appoint a member to serve until the first Monday in January following the nextregular municipal election; at which election a successor shall be elected to serve for the balance ofthe unexpired term, if any. If the vacancy occurs at a time when the affected city or town determinesthere is insufficient time for candidates to seek election as a member, appointment shall be made untilthe next following election.

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Page 4

SECTION IVAPPORTIONM ENT AND PAYM ENT OF COSTS INCURRED BY THE DISTRICT

Classification of CostsFor the purpose of apportioning assessments levied by the District against the member municipalities, costs shall bedivided into three categories: capital costs, operating costs and transportation costs.

A. Capital CostsCapital costs shall include all expenses in the nature of capital outlay such as the cost of acquiring land, thecost of constructing, reconstructing, and adding to buildings, and the cost of remodeling or makingextraordinary repairs to a school building or buildings, including without limitation the cost of the originalequipment and furnishings for such buildings or additions, plans, architects' and consultants' fees, gradingand other costs incidental to placing school buildings and additions and related premises in operatingcondition. Capital costs shall also include payment of principal of and interest on bonds, notes or otherobligations issued by the District to finance capital costs. Capital costs will include capital outlayappearing in the 7000 DESE functions codes.

1. Apportionment of Capital CostsCapital costs incurred in connection with the construction, equipping and placing in operation ofthe initial district school building, including the payment of principal of and interest on bonds,notes or other obligations of the District issued to finance such capital costs, shall be apportionedon the basis of the member municipalities' equalized valuations and population, determined as toany member municipality by adding together the ratio which its equalized valuation bears to thetotal equalized valuations of all the member municipalities and the ratio which its population bearsto the total population of all the member municipalities and dividing this sum by two. Equalizedvaluation as used in this clause (I) shall be the valuation of each member municipality asdetermined by the Massachusetts Department of Revenue (DOR) and population as used in thisclause (I) shall be the population of each member municipality according to the latest state censusas determined by the DOR. The ratio for each particular borrowing shall not be changed duringthe period in which such bonds, notes or other obligations are outstanding except when a newtown or towns are added to the district whereupon the capital cost will be recalculated consistentwith this section (I). Also, the capital costs will be recalculated upon adoption and acceptance bythe towns of Cheshire and Lanesborough.

2. Capital costs other than those apportioned pursuant to clause (1) of this subsection shall beapportioned consistent with Section B (1).

B. Operating CostsOperating costs shall include all costs not included in capital costs as defined in Section IV (A), includingbut not limited to interest on temporary notes issued by the District in anticipation of revenue.

1.Assessment of Operating CostsOperating costs will be assessed to each member municipality using the statutory method. Foreach fiscal year, the assessment of operating costs for each member municipality will be the sumof the following: (a) the member's required local contribution to the District (municipal minimumcontribution) as determined by the Commissioner; (b) the member's share of that portion of theDistrict's net school spending, as defined by M.G.L. c. 70, 2, that exceeds the total of therequired local contributions for all members; and (c) the member's share of costs for transportation

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Page 6

2. All amendments to this regional agreement must be presented to the Commissioner ofElementary and Secondary Education in a timely manner prior to scheduled town votes.All amendments, including an amendment to add a new member or to provide for thewithdrawal of an existing member is subject to the approval of the Commissioner. A newmember may be admitted to, or an existing member may withdraw from, a regional schooldistrict as of July 1 of any fiscal year, provided that all requisite approvals for suchadmission or withdrawal, including the Commissioner's approval, shall be obtained no laterthan the preceding December 31. The authorizing votes may provide for the deferral of saidadmission or withdrawal until July I of a subsequent fiscal year.

B. ProcedureAny proposal for amendment, except a proposal for amendment providing for the withdrawal of a membermunicipality (which shall be acted upon as provided in Section VIII), may be initiated by a two-thirds voteof all the members of the Committee or by a petition signed by 10% of the registered voters of anyone ofthe member municipalities. In the latter case, said petition shall contain at the end thereof a certification bythe town or city clerk of such member municipality as to the number of registered voters in saidmunicipality according to the most recent vo ting l is t and the number of signatures on the petition whichappear to be the names of registered voters of said municipality and said petition shall be presented to thesecretary of the Committee. In either case, the secretary of the Committee shall mail or deliver a notice inwriting to the selectboard of each of the member towns and to the city council of North Adams that aproposal to amend this agreement has been made and shall enclose a copy of such proposal (without thesignatures in the case of a proposal by petition). The selectboard of each member town shall include in thewarrant for the next annual or a special town meeting called for the purpose an article stating the proposalor the substance thereof. Such amendment shall take effect upon approval of the Commissioner and uponits acceptance by all of the member municipalities, acceptance by each town to be by a majority vote at atown meeting as aforesaid and acceptance by the city of North Adams to be by a majority vote of its citycouncil.

SECTION VIIADM ISSION O F ADDITIONAL TOW NS TO TH E DISTRICT

By an amendment of this agreement adopted under and in accordance with Section VI above, any other town ortowns may be admitted to the regional school district upon adoption as therein provided of such amendment andupon acceptance by the town or towns seeking admission of the agreement as so amended and also upon compliancewith such provisions of law as may be applicable and such terms as may be set forth in such an amendment.

SECTIONVmWITHDRAWAL

A. LimitationsThe withdrawal of a member municipality from the District may be effected by an amendment to thisagreement in the manner hereinafter provided by this section. Any member municipality seeking towithdraw shall, by vote at an annual or special town meeting in the case of a town or by vote of the citycouncil in the case of the city of North Adams, request the Committee to draw up an amendment to thisagreement setting forth the terms by which such municipality may withdraw from the District, provided(1) that the municipality seeking to withdraw shall remain liable for any unpaid operating costs which havebeen certified by the district treasurer to the treasurer of the withdrawing municipality, including the full

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Page 8

SECTION XTHE TRAN SIT IO NAL COMM IT TEE

Within ten days after the adoption and acceptance of this amendment, the school committee of each newmember municipality shall appoint one member from its own membership to serve on the transition committeeuntil a successor is appointed or qualified as provided herein, however, that the term of office of a person soappointed shall forthwith terminate if such person ceases to be a member of the local school committee fromwhich such person was appointed.

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Page 10

APPENDIX AAssessment of operating costs will be assessed using the statutory method as outlined below:

A. For each fiscal year, the assessment of operating costs for each member town will be the sum of thefollowing:

1. The member's required local contribution to the District as determined by the Commissioner;2. The member's share of that portion of the District's net school spending, as defined by GL

chapter 70, section 2, that exceeds the total of the required local contributions for all members;and

3. The member's share of costs for transportation and all other expenditures (exclusive of capitalcosts as defined under Section V, C below) that are not included in the District's net schoolspending.

A member's share of (b) and (c) above will be calculated on the basis of "foundation enrollment" as defined in G.L.chapter 70, section 2 based upon, the October 1 enrollment from the previous fiscal year. That is, for any fiscal yeara member will pay the same percentage of (b) and (c) above as that member's foundation enrollment.

B. Example: Budget (dollar amount)Minus Total Required Local ContributionMinus Chapter 70Minus Local Revenue

If there is a remaining amount, then that amount is divided among member towns according topercent of pupils.

C. Sample: Budget-SampleTotal Required ContributionsChapter 70Local Revenue

$10,000,000- 4,000,000- 2,000,000- 1,000,000Amount to be Apportioned $3,000,000

Town A 30%TownB 25%TownC 25%TownD 20%

$900,000750,000750,000600000

Amount remaining $3,000,000D. Required contribution + amount remaining +transportation cost = assessment

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( ! C i t ! ' o f ~ortb ~ b a m s] n < ! C i t p < ! C o u n c i l

A p r i l 2 4 , 2 0 1 2........................................................................ ' .

BE IT ORDAIN ED by the C ity C ouncil of the C ity of N orth A dam s as follow s:

T hat C hapter 13, Sec 13-49 of the C ity O rdinance of the C ity of N orth A dam s bean d are h ere by am end ed b y d eleting th e en tire West Main S tree t sec tio n an dr ep la cing w ith th e fo llow ing:WestMain Street, so uth erly sid e from P ho en ix B rid ge to B rown S treet, ex ce pt

for a se ctio n from a p oin t 2 5 feet w esterly o f the interse ctio n o f F urn ace S tre etan d ex te ndin g w este rly 8 5feet. N orth erly side , b eg in ning at a p oint 10 0 fee te as te rly from th e in te rs ec tio n o f th e e as te rly lin e o f Good ric h S tre et, th en ceex ten din g w esterly to a p oin t 1 00 feet w esterly o f th e in tersection of w est lin e o fG oo drich S tre et; 1 57 fee t from easte rly cu rb lin e o f G rim e S treet an d e xten din gea sterly 5 7 fe et. S ou th erly sid e, b eg in ning at a p oin t 2 0 fe et easterly o f th eso uth erly ex ten ded east lin e o f G oo dric h S treet an d ex te nd in g w esterly to a p oint20 fee t w esterly o f th e sou th erly ex ten ded w est lin e o f G oo drich S tre et.

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O ffice of the C ity C ouncilCity ofNorth Adams

10Main Street Room 109North Adams, Massachusetts 01247

(413) 662-3015

April 1 8, 2 01 2

Dear Fell ow Council or s;Unde r Chapte r 2 e ntitle d Admin istra tio n, S ec tio n 2 -1 , re gu la r me etin gs a re h eld a t7 :3 0pm. I w ou ld lik e C ou ncil to co nsid er ch an gin g th e tim e o f o ur meetin gs.I'm p ropo sin g 6 :00 o r 6 :3 0 fo r c on sid era tio n.I would app re cia te o th er c ounc ilo rs in pu t on th is ma tte r.

SincerelyJ enn if er B re en K ir sc h

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FEE s 100.00~:

COMMONWEALTH OF MASSACHUSETT SCITY OF NO RTH ADAMSA P R 1 2 2012

DATE

I H EREBY MAK E A PPLICA TIO N TO BE G RANTED A ;U CEN SEas a dealer in and keeper of a shop for the purchase, sale, or barter of junk, old metals orsecondhand articles as defined in Chapter 10, Section 10-1and Section 10-2(a) of the RevisedOrdinances .in the business name o f E _ - m . . . : . . . y . f _ _ : _ ; t':s-: _

f J, . 1 1 . ' / > 1 Sf.located at ___;le'----v--'-/_~_ , (_--,- _hours 0; OPl'rationJ:>e. I l ! j 10: 00 /lM liY J ? : 0 0 / ' t ! 1 .

I hereby certify that, if granted this licen se, I w ill strictly conform and adhere to th elaw s of the C ommonw ealth, the ordinances of the C ity and such rules and regulations asth e C ity Counc il may e sta blish

a ure of Applicant **Social Security Number (Voluntary).... r C . o.rp..orate. N a m . . e.. ... . . or Fedeyu}dentification ~ber. . .

_ __ _I()ZJ.-)14 ..C.~L-#i-J4d----a-t-U//-I-I+-4~?k--#fIf-#FO/...1-f;>ResideD.tlalAddress

ena ltie s o f perjury that 1 ,to the best of knowledge andrns and paid all State Taxes required under law .

* T his lice ns e w ill n ot be i ssued un le ss thi s cer ti fi ca ti on c lause i s s igned b y the applicant* * Your soc ia l s ec ur ity number w il l b e f ur nished to th e Massachu se tts Departmen t o f Revenue todete rm ine whe th er you have met ta x f il ing or t ax payment obl igat ions . L icensees who fai l t o cor rect t he irnon-f il ing or del iquency wil l be sub je ct to lic en se suspens ion o r re voca ation. This re ques t is made underth e a uth ority o fMGL Cha pter 6 2C , S ec tio n 4 9A .

DEPARTMENT O F PUBL IC SA FETYThe above app lic ation is h er eby APPROVED X . ,_ _ ___;DISAPPROVED_ _this t ? day?f j) P & ' f in th e yea r 2-C(~keeper ofn junk shopTEN(A).DOC

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City Of North Adams

To.The Honorable City Council:I, ~I"'~ l 1 t / . J , . y ,hereby make application to.be granted aLICENSETON~fTAXICABFOR Yj;ne/'eO?A-Q &L ...

Empl oy er 's n ameHeight~ ft_ z _ in Weight2.@lbs Color of Hair /~tV1 Color of Eyes .{1rt 'e01Date of Birth _ a l L!irthplace 4/~ t1tf .Gender /P1 Citizen .k:_I held a Massachusetts Driver's #long 1 1 1 2 Y.Ie! .'"

and have held this license fer hew

My license has__ has net~ been suspended or revoked in Massachusetts or any etherjurisdiction.

ffyesexplrun ~---I have __ have net~ been convicted of a felony. If yes explain: _

Are you currently en any medication that would hinder your driving ability yes_,noX_.De you currently have any open crucinal court cases, yes__ , no.L.Explain en page 2.I HEREBY CERTIFY THAT, IF GRANTED THIS LICENSE, I WILL STRICTLY CONFORM ANDADHERE TO THE LAWS OF THE COMMONWEALTH, THE ORDINANCES OF THE CITY ANDSUCH RULES AND REGULATIONS ASTHE CITY COUNCIL MAY ESTABLISH.

I do solem nly, sin cerely and tru ly affrrm th e fo reg oin g ap plication to be true to th e b est o f m yk now ledg e and b elief and d o so un der th~~ /

I / / "Address a__t1~d(fTd"v/'t4 ~$. City/Town a TO BE COMPLETED BY EMPLOYER TO BE COMPLETED BYTHE POLICE DEPTrms IS TO CERTIFY THAT:1[:.TAXI DRIVER'SLICENSE

er1uto dhName o f a pp li ca ntW&l: ; r~TAXI OPERATOR'S SIGNATURE