HomeMy WebLinkAbout12-032Ir
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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
1. Name
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
Middle
) is ., .J
Last
C) --_--3Z
(Office Use Only)
2. Mailing Address 2_17o $ '1' QCf0 2c_ o ✓-- (A 'r)
3. Telephone: Home 3q "e_141 ) )13 0 Other: '1 3
4. Prior experience in transportation of passengers: Yew -�
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? !V d
Type of offense
Where
When
6. Have you b ergconvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?
Type of Offense
Where
7. Have you been convicted of any traffic offenses in the last five years? V e -
When
Type of offense Where When
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8. Has your drivers license or chauffeur's license been suspended or
Type of offense Where
c y9/ 7— o
in the last five vear ?
When
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
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) The re-
port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli-
cation.
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
cleh/ ,dnWadg 09/2010
I j reby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number 1
7 �� �! �� O% 5 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 �� C Date Z� ti
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STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by AGi i I �C� CX yu S On this Z day of
2012 // r._ / ,I
1 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).
Signatu of Poll, ie r designee
A � h" . 4:��
Signatnfe of City Clerk or designee
a' /.?- /a
Date
.Z -/I -/Z.
Date
After Police Chief and City Clerk have approved authorized taxi driver names will be placed on the city website at icgov.org.
Taxi cab businesses are required to provide Driver Identification cards.
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Office Use Only
Approved application
DCI report
State certified driving record
Website update
de".dnwa ,2010 dog 09/2010
Feb. S. 2012 4:07PM �Div�of Criminal Investigation 0%3123PP.L2/3
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Received Time Feb, 2. 2012 9:47AM No..2318
CA
Iowa Department of Transportation
Office of Driver Services (Toll Free) 800-532-1121
FO Box 9204, Des Moines, IA 50306-9204 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
2/2/2012
DL/ID #:
713YY6075
Customer #:
431346
Name:
Adams, Adll Daoud
Class:
A
ID Status:
None
Address:
2608 BARTELT RD APT
Audit #:
4078525
DL Status:
VAL
_
Fall to Obey Traffic Sign/Signal
2C
Issue Date:
02/05/2010
CDL Status:
VAL
City/State:
IOWA CITY, IA
Expiration
01/01/2015
CDL Cert
None
Days Remalning on IID .
522462730
Date:
IID Required Through
Status:
SR22 Required Through
Endorsements: LNPT
CDL Med
None
j
Probation In Effect
Status:
Mailing Address:
2608 BARTELT RD APT
Restrictions:
Except Class A Bus
Restriction
None
2C
Date of Birth:
1/1/1959
Supplement:
Mailing City/State:
IOWA CITY, IA
Sex:
M
522462730
History Information
Convictions
Citation Date
Conviction Date
ACD
Explanation
County_ ]UR
10/19/2008
112/31/2008
lM40
_
Driving Where Prohibited
_
SIL
_
12/05/2010
_ _p /18/2011 _
N40
_ jImproper Signal or Failed to Signal
_ _
52 lA
08/18/2011
109/29/2011
M14
_
Fall to Obey Traffic Sign/Signal
_
52 IA
Compliance Item
Status
Additional Information
Earliest Reinstate Date: Non -Commercial
I
Earliest Reinstate Date: Commercial
Active Judgements
0
Life Sanctions
,0
_.._ .._. ..__
Incapables
..,___ __
'0
`
_ r--
_.__ __.____. ______.______.__._._.___ __._._
Indefinite Sanctions
_.... ...... _.._
'0
Civil Penalty Owed _
...�0___
Drinking Driver School
.._.__
Treatment &Evaluation
Days Remalning on IID .
0
IID Required Through
SR22 Required Through
NOT REQUIRED
Financlal Responsibility
j
Probation In Effect
Number of Unserved Sanctions
Pending Drug Revocations
;0
,
Name: Adams, Adll Daoud DL/ID: 713YY6075
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