HomeMy WebLinkAbout14-174ic�i�I@Ili'
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
IFirst
1. Name ,; VV711.e-
2.
3.
13
Authorization Number_g/ --L--? q
(Office Use Only)
._..kj,3 e.�t' V�
Department
between 8 a.m. to 3 p.m., Monday — Friday.)
Last
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Mallin Address p _--
�,�p
IeYephone: Home a✓�>= Other':
ta—�`_�._. ¢ _�
Prior experience in transportation of passengers; ,........ _ _.............
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?—H-.O= rve')'-4�
Type of Offense Where When
7, Have you been convicted of any traffic offenses in the last five years?
8. Has y. our driver's license or
Type of offense
Where When
��r Po2 � r: rs1 �"`"�• a� �
license been suspended or revoked in the last five years?fir" 4L -4EC
Where
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
0/
r s r t
r' R r • • • • qt.
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
de,xnma.;,t 0312014
e Iowa Department of Transportation a valid Chautfeurs license number
I h certify that) have issued to me by the 1 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 a!I of the provisions of Title 5, Chapter 2, of the City Cade. (Needs to be signed in front
of a Notary public)
Signature of Applicant ° °::'..:M �Date-
YOU ARE NOT VALID TO DRIVE A TAXI iN ICWA 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 _Wyand sworn
99 to before me by On this , " day of
K\ AG � �•"1'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 p lice Chief or designee
T
Y2� I //
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.
Signatu'h§ of City Clerk or designee
91
Date
Taxi cab businesses are required to provids Driver Identification cards. Cards must be 8'/2" (width) and 51/2"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
derk&vddr1vbadgeapp2014.d= 0312014
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SMARTER MAKER I CB. MM ",
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FIG Box. 924 l T.9 .° hlrepmn, Uk FQ30S-92U
1a%xuur'rBE"�''J.r.44''^'7V.14PBCIRA"rci.:nrx St°T E:.iaxG 1.5-2.394937
WNW, fnwaalrat' go
Ceftliflied Abstract of 11i (Record
Inquiry Benin
8/20/2014
Dli
775ZZ6832 (IA)
Customer s
3874967
Namos
Mohamed Bakhelt, Ismail
Clasc
D
IDStatus-
None
Address:
1837 GRYN DR
Audit;
8317464
DL Status:
VAL
Issue Data;
08/02/2014
CDL Statues
None
Cuty/Statm
IOWA CITY, IA 5224 06
ENpiratlon Date,
07/04/2019
CD&., Ceir't Statuum
None
Endursomentso
3
CID1L (Med atus:
None
Mailing Address:
1837 GRYN DR
Restrictions:
NONE
Restriction
None
Date of Birth:
7/4/1959
Supplements
Mailing City/State: IOWA CITY, IA 522464406
Saar;
114
Nllatory lInfforTmatlon
Conviction CK", ACD Esepl""mation Counv, 311 .
rS92 ..... S recd _ w ,... ..., Iohn son IA
1i . 'Improper Backing� Dohnson . � ^� YA4
Accidents - Accident Involvement Indllcalled does HOT 11nean the Indlvidual was at ffaDllt or given a cttatiDn„
Date
Pursuant to Iowa Code 8321.10, 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:
8/20/2014
,°. '` Office of Driver Services
times
Iowa Department of Transportation
Name: Mohamed Bakhelt, Ismail DL/IDs 775ZZ6832
MAI V, LV I I jt �:.0 ,A. C i,v v,Y,.r,' nal , n eunu ,t, on N...1 P• M.
A'^ 12. 2014 i1:00AM Div of Criminal Investigat on No. 7094 P, 2
STATE OF IOWA.
Crimmi al ffistorylkecord Check
Request Form
.,o IowaD'A.'viaa%wafrrriniinol..kwwd,reCdo¢a
Support operaftattoDueesau, &R`Ftenu
2t5' E. "Va` Stv". 1
nrn Moines, Iowa So -319
(515) 7.25-6066
(SAM) 72.54020 'Far
DCT Account Number:........Qtiu .yw$
(0rsugwRdra6Yaa)
FroM:.....Cq?V CU.k.f(Pa'P1i e% Q:aU:......................�.._____..............
6y,derk'a 0frice
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Iowa CRY, TA 52240
Phone: ',@Il...... 6Utf.
gym- "''. �' ---- it
la a w. .. a .... ! e 1 � m e roCl use only)
a search of tha provided name and data of birth revealed;
No Iowa Q iminalal E istony l2ecotd found with 1)Cl
J
Iowa Criminal History Record attached, DC1 # ,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,, _
Received Time7Aug: 6.-1(2014 10:10AM No, 6437