HomeMy WebLinkAbout14-237CITY F IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
1. Name (HPCkB..ilOdEE))
_
Authorization Number ) 4 — ��°2ro � -7
VeAl a vi (10'A' (Office Use Only)
APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.)
�w (tt p a�w p a pw�r &tfw ldarn_R" aaa p °" �gfd , fmatlon ill result a°tt, formal f the vt� /IE 4a��i
Middle
Last
2. Mailing Address (IREQt1ED)
3. Contact Information (REQUIRED) D) Email: c - n fbhp ,.... hA ') 4r 1 Cell Phone: 3 /1 3 , "2. .VIL/
4. Prior experience in transportation of passengers: ;3 `A:9C
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
I
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or
years? @ a
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T14rt
ij+t
N o
#m last five
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7. Have you been convicted of any traffic offenses in the last five years? PQ
Tips of offense
Where
When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? P40
Type of offense
Where
When
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
N 9
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).
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
09/2014
I hereby certi that i have issued to me by the Iowa Department of Transportation a valid Chau feurs license number
5.217 �/ �°, `i ,. 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 withForfile-dWisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public) j L
Signature of Applicant 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 i v., g -r•, < W1 On this '1C` day of
e' -v 4'n, A n 1r, '5( til L1
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).
' c2 O-/'/
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.
Signa re of City Clerk or designee
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and 5 1/]"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
ClmkrrAXIDRIVBADGEAPPL92014amended.DOC 09/2014
Oct. 8. 2014 11:06AM Div of Criminal Investigation No. 1476 P. 2
i1. 6. 2014 11:16AM City Clerk - City of Iowa City No. t;2/5 P. 7
To:, Iowa 1 IVIofoAn of O dWnA Ave fliga tlou
5Wuppork 1npmeafloKEl8ft` lu, ��P tWPJR°
215 X 7" Street
Des hsdaolueg;, laws 5031.9
6"sE50129.6066
(515) 9Z5-6080 Fax
DC%Account Number: •q 2_'
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Phone: '356,5041
Fax: 115 „�5'7�569�
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jMh
of p a search of the provided name and date of birth re�vcatcd;
No Iowa Cr" nal ;Elisto a •.Rorord found with DC.1
El Iowa Ctlminai History Record attached, DC1
iv
W.Unitsals.
Received rimea'Oct. 6,n2014 11:16AM No, 1348
Yi
00T wi
TH SP�r P CRI I CUSTOMER DRIIVID1
n ; � ,u
Off§i'.V of DiriCkuier fsdl"!K2cas
If Q Box %�0a. 4 9 De Ihftmiinem, A159306 9A4
Fhone:sa52 -4124100-537-1121l:f 1w 51r5-2.39IA'37
RIM
17.61
10/17/2014
Adarob, Mukhtar
Mohamed
1424 DENALI Ci
CORALVILLE, IA
522411382
�F•,fl'FI i ITT C+�I�ll1I"�IL1:14(Y
Mailing City/State: CORALV%LLE, IA
522411382
Certified Abstract of DrIlvIlrig Record
DL/ID #:
527AG8848 (IA)
Customer to
5836959
Class:
D
ID Status:
None
Audit #:
8509059
OL Statue.
VAL
Issue ligate:
10/07/2014
COL Stature
None
(Expiration
10/14/2016
CDL Cart
None
(Date::
Status:
IEindorsementm
2
CDL Mad
None
Status:
Restrictions:
NONE
Restriction
None
Date of Sl :
10/14/1969
Supplement.
sem.
M
CLEAR IDRIVIING RECORD
Name; Adarob, Mukhtar Mohamed DL/ID: 527AG8848
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.
INrima; Adarob, Mukhtar Mohamed DIIJIDc 527AGS848