HomeMy WebLinkAbout14-161410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319)356-5497 FAX
1. Dame SU
2. Failing Address
11
Authorization Number Lap t
(Office Use Only)
Ca
Depbetween 8 a.m. to 3 p.m., Monday — Friday.)
artment
4. Prior experience In transportation of passengers:_
Last tl ) M
-J fl a wa r i—i-4 J
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 110
Wn
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
'(
years? •. V _
Tvoe of Offense Where When
7, Have you been convicted of any traffic offenses in the last five years?
WM
8. Has your driver's license or chauffeur's license been suspended or revoked in the last fiveyears? b
Where
MM
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
IV 0
.. •. - • • '... l.. i . i a
I] V Vi 10 Eel V =A*] Volklit I i-IFA41fiellyi I Vjo VA I W I L4—, I :j Ulgol-ai I[$] I 11$] A ;Lei IN LAM 4al W I I ;J - a i
You must apply for an individual Department of Criminal Investigation Report (form available upon request).
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
daNOadddWad® 03/2014
rebyy certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
3 L A k T2— % 1 . 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 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 Date OU ® f
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 )
COUNTYOFJOHNSON )
Subscribed and sworn to before me by _ tyA�_" __, i . _r , On this day of
No ry Public i nd for the State )fj1owa
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 welfargsd#`re*erda-bf"the City of Iowa City (Title 5, Chapter 2, City Code).
or
,..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.
Signature of City Clerk or designee
ate
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/2" (width) and 5'/2"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
de,Kna,aadwadeeaa zot4.ez 03/2014
j � %J
10'
e%i��i ,,,,:/ratePO Roy qrM4 Mm RA 593N.3 -9,.M4
Inquiry Data® 8/6/2014
Name: All, Sultan Dirar
Addrown 2658 ROBERTS RD APT 2D
IOWA CITY, IA 522462
Mailing Address; 2658 !' R )
Mailing City/State: IOWA CITY, IA 522462743
Name: All, Sultan Dirar DL/ID: 832AK7271
t,r „ y€ 11
DL/XD
832AK7271(IANJ
Status:Customer
ID
Audit 9:
8327271
Issue Datet
08/06/2014
Expiration +a:,; 01/01/2022
Endorsements:
2
Restrictions:
NONE
Date of Birth;
1/1/1962
u
i �
#:
6258171
Status:Customer
ID
DL Status.
VAL
Call. Statmu
None
COL Cart Status:
None
Ds Mod Statusi
None
Restriction
None
r y - 0 All Pill!
s'
�101 h AM, 4144
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:
°••°••• Office of Driver Services
Iowa Department of Transportation
Name: All, Sultan Dirar DL/ID: 832AK7271
Aug. 12, 2014 2:23PM Div of Criminal Investigation
V. LV III T• V V. 1 L I (J v l b i n V I J u 1 l V n 4 V I L
`•�Y O� eVV• LVI ••JJ•„ Lv • �• •11• `IiM•I V11
I1 ar, 1 IOWAis
( �� 11 Request Form"
Tol Iowa Wgfilone of� uCue�purcak Yua�oxah�aakoua
Oapport Otuaaa lotk D uyaaaa®1" Now
1-18 n17!" ataoat
1'11517:11-dw
(61.6) 7,x5Adaao .Pax
NNo.�6840 PP. L2 1.
/2
/ •J
�.��'.I.�.C�Bball$kt �au�umara ' % L'� � •'�, w, p„'J"
-------------------
C dye 01006 Ofdtao
dS�IO,`i�aaDaBum Yotta�art'orae _______,
On a it Ik saaaa_ ------------------------
Received
___
Phonon 3:d3�xE6W�--
Natt1 '9A4?d,i67---------------
o
�? � __ a kaA. g59�a�.�" e�@�Q9�'9A R&� ` URAIL� • (A'CTwoonf>I)
Aa of , P.yewchoftheprovided namoand datoof hdirevealed; f"
CI IA
NoIowa Q nal kilatoryPccordfoundwith D01
CD
Iowa Q)mine( X3(Irtory Itecoid attached, DCI #
�t�xiraltdaia � ___-•
Receiv d�TimeAfAug•ti6,'t20147.4:04PM�No.ti6517