HomeMy WebLinkAbout14-273Iwo I
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
1. Name (REQUIRED)
Authorization Number �'� •.....I T3
._._ (Office Use Only)
1� (�R')o W r
APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.)
Failr�r� to conlg(at_E►�so `" .._ teerc:�!" ►nB'arrre�f►r�n uv1►d e¢�satlf_frr_ar�eal�1 gf the a ►►catlorr
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2. Mailing Address (REQUIRED) -/ Li -2, Li Fa;tfeV5Wee
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Information3. Contact
s Prior experience in transp • of passengers:_I:__
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—Cell Phone:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? tj ii
Where
BR „ o.iuty u�r,
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6. Have you been gonvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?b
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7. Have you been convicted of any traffic offenses in the last five years?
Type of offense
Where
When
When
B. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? � ) t.)
Type of offense
Where
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9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the Reme(s)
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DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIF
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF RE
You must apply for an individual Department of Criminal Investigation Report (form avallable upoo"requesif
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
Cxt
0912014
hereby ce i tatve i�ss to me by the Iowa Department of Transportation a valid Chauffeurs license number
j� t L . I understand that if I falsely answer anv ouestions 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. (Leeds to L•e signed in front
of a Notary Public)
j
Signature of Applicant I + �'' s Date
YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY
CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org.
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by 1r'aSA` 7`: fit rx4 <..r, ®. On this 1.'x.. day of
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).
Signature of Poli „Nf 6r designee Date
YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY
CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org.
ign*t re of City Clerk or designbs.
--- ( / �.
D to
Taxi cab businesses are required to provide Driver identification cards. Cards must be 81%" (width) and 51/211
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
CIAAVTAXIDR.VRADGFAPPL92014amerded.DOC 092014
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Support Operations Bureau, IV, Vtook,
215 F. 7'h Street
Des Mrsilles, Iowa 50319
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be YreYr:raaAble, Per coda of fosrraa chalntW 012, Yoe Pyfiakk uo"Ygtt PAI tatatoq record infhrnrmarloss, as abfaawVwed by Ynwirn atauaa,,ta
Waller Release: I hereby glvo permission for die store rogoasliM otrniai to Conduct an Iowa aiumal history record check with me Division ofCominal
favasligarlon(bC0. Any oflfnmal history dela conserphsgma shat is mainlalned hylhe DCl maybe rAWA ea allowed by law,
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�.� Iowa a-Iminal H4stozy Record attached, DOf
DC1 initials....% . .................... 4...._.._.
Ae ved T'irne- &J. 21.'QW 1191PM No, 3561
Inquiry Date: 11/20/2014
Name: Abbashar, Yasir Ibrahim
Addresoz 2424 BITTERSWEET CT
City/State: IOWA CITY, IA 522464
Mailing Address: 2424 BITTEPSWEET CTI
Mailing City/State: IOWA CITY, IA 522464100
DOT
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PO Rox W..04 r. „Wn i s GA 503CS 9:254
Phre 515 744AU4II,6003 '32 1121 CFax:5'.5.7-i�9...V1'3'7
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DL/ID #: 658A15404 (IA)
Clasm D
Audit #: 6585404
Issue Date: 01/03/2013
Expiration Datm 04/29/2018
Endorsomentm 3
Restrictions: NONE
Date of Birth: 4/29/1972
Sex: M
Nams: Abbae:har, Yash Ibrahtrn DL/ID: 658A:5404
Customer #:
6051382
ID Status:
None
DL Stator:
VAL
CDL Status:
None
CDL Cart Statusn
None
CDL Med Statuan
None
Restriction
None
Supplement:
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WA 41"1
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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:
Name: Abbashar, Yasir Ibrahim DL/ID: 65BA15404
.."
11/20/2014
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t'`•••••' info
Of0ee of Driver Services
Iowa Department of Transportation