HomeMy WebLinkAbout12-045Authorization Number 1,9-- J- -
r 1 (Office Use Only)
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CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER
(Police Department review must be made
410 East Washington Street between 8 a.m. to 3 p.m., Monday— Friday.)
Iowa City, Iowa 52240-1826
(31 9) 356-5040
(3 19) 356-5497 FAX
First Middle Last
1. Name MAHAMAbo u' /t/ �/4 T I>OR
2. Mailing Address li IS ARE AVE API Jaw L. fA4 7 A t L16
3. Telephone: Home I Other:.�, o .a�_J� -
4. Prior experience in transportation of passengers: IL
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense Where When
6. Have you b_e�n convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? //-`•a
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where When
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8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
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) _ /A
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 -
rt will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli-
tion.
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
derkhmidrivbacg 09/2010
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
9 "Z5'q o $ . 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, low- ^
their discretion, to examine any and all records and documents relating to this application, and I further agree that, if a Iic(
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 I --
of
.. -of a Notary Public)
Signature of Applicant TA ,A" Dateq_/zf. ),C J,
STATE OF IOWA )
COUNTY OF JOHNSON ) I T
crib d and swom to before me by ft,kCLO--6-30-v- I V a - Off., On this 2 z day of
1 20 J zl�L�
-:'-7-7 �. =. i_ K TUTLE Notary Public in and for the State of Iowa
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).
Signa re of Police Ch/i/ r designee
�L40�t 9C
Signbture of City Clerk or desig e
7via-
Date
C2 -aa- /J"
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.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
detlN dnvbadgeapp2010d« 09/2010
Fe6.20. 2012 9:56AM Div of Criminal Investigations rNo.4644 fP. �1/1
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JJCI.77 (OM25/10)
Received Time Feb. 14. 2012 8:45AM No, 3830
Iowa Department of Transportation
iL Office of Oliver Services (Toll Free) WU-532-1121
PO Box 9204, Des Moines, lA 50306-9204 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
2/7/2012
DL/ID #:
960ZZ5901(IA)
Customer #:
362217
Name:
Traore, Mahamadou
Class:
D
ID Status:
None
Address:
1615 Aber Ave Apt 1
Audit #:
2331927
DL Status:
VAL
Issue Date:
07/15/2008
CDL Status:
None
City/State:
Iowa City, IA 52246
Expiration
07/08/2012
CDL Cert
None
Date:
Status:
Endorsements:
3
CDL Med
None
Status:
Mailing Address:
1615 Aber Ave Apt 1
Restrictions:
NONE
Restriction
None
Date of Birth:
7/8/1978
Supplement:
Mailing City/State:
Iowa City, IA 52246
Sex:
M
History Information
Convictions
CftatFoo Date Conviction Date ACD Explanation County IUR
04/22/2009 _ X05/19/2009_ _ ._ S92 Speed _ 52 IA '
10/07/2009 01/27/2010 S92 Speed '52 IA
Name: Traore, Mahamadou DL/ID: 96OZZ5901
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 offlce, 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:
`......... X9'4
2/7/2012
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Office of Driver Services
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Iowa Department of Transportation
Name: Traore, Mahamadou DL/ID: 960ZZ5901