HomeMy WebLinkAbout12-058� r 1
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
First
1. Name
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
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I
(Office Use Only)
2. Mailing Address�lh.\O SV\K1A it C) c K \�\-
3. Telephone: Home �%9) .351 — I CAU l Other:\`A) Lk
4. Prior experience in transportation of passengers:
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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 been convicted 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?
Type of offense
Where
When
When
8. Has your drivers license or chauffeurs license been suspended or revoked in the last five years?
Type of offense
Where
When
9. Have you ever applied to bean 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)
deWuidrivbadg 09/2010
I hereby certify that I have is ued to me by the Iowa Department of Transportation a valid Chauffeurs license number
'R y ZZ S 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 -1 �— / 1 /`` Date �_ I 2'3 1 \
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by \�� �tO���1� ��� On this 'z-+kms
day of
<< ,..� 113114
�Nc Public in an for th 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).
Siiggnya�tur of Polic ief or designee
Signature of City Clerk or designee
Date
d -a? -/a
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
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Feb. 22. 2012 11:14AM
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CrIru Mal.History Recoird Check
Request Form
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Received Time Feb, ib. 2012 10:20AM No.9435
Iowa Department of Transportation
►�'� Office of Driver Services (Toll Free) WD -532-1121
PO Box 9204; Des Moines, 1A 5030"204 515-244-9124
'FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
2/16/2012
Name:
Gaber, Yasser
CDL Med
Abdellateef
Address:
3410 Shamrock Drive
City/State: Iowa City, IA 52245
DL/ID #: 845ZZ5158 (IA)
Class: D
Audit #: 2460462
Issue Date: 08/20/2008
Expiration 08/26/2013
Date:
Endorsements: 3
Mailing Address: 3410 Shamrock Drive Restrictions: Corrective Lenses
Date of Birth: 8/26/1962
Mailing City/State: Iowa City, IA 52245 Sex: M
History Information
CLEAR DRIVING RECORD
Name: Gaber, Yasser Abdellateef DL/ID: 845ZZ5158
Customer #: 2845716
ID Status: None
DL Status: VAL
CDL Status: None
CDL Cert
None
Status:
CDL Med
None
Status:
Restriction
None
Supplement:
Iowa Department of Transportation
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.
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:
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2/16/2012
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Office of Driver Services
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Iowa Department of Transportation
Name: Gabor, Yasser Abdellateef DL/ID: 84SZZ5158
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DRNER LICENCE
GABER
a�YASSER ABDELLATEEF
3410 SHAMROCK SHAMROCK OR1VE -
IOWA CITY. IA 52243
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