HomeMy WebLinkAbout12-069CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(mot ;56-5040
(319) 356-5497 FAX
Authorization Number /a .G i
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
Middle
2. Mailing Address 9 � ` et Le�i(2 d
3. Telephone: Home Other:
4. Prior experience in transportation of passengers: AA 1. i Vr U .S
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?
When
Type of offense Where When
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)
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)
clerWt xidrivba g 09/2010
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
t��� A -F 7 C . I understand that if I falsely answer any questions in this application, that this
application may a de led. 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 ApplicantJaL&::Jew L,4ZSlL_- Date 0 � _ 2 g —P o I;-
STATE
Z
STATE OF IOWA )
COUNTY OF JOHNSON )
dubs riand {sworn to before
—_-A (
me by
0.1a1ejd r_ 4
KELLIE K. TUTI Lt
Public in and
On this Z I / " day of
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).
of P fc Chief or designee Date
mil/
of City Clerk or designee 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
der Mt idnvbadgea,2010,d 09/2010
Iowa Department of Transportation
AW Office of Driver Services (Tall Free) SUO-532-1121
PO Box 9204, Des Manes, IA 50309204 515-244-9124
FAX: 515-239-1037
Certified Abstract of Driving Record
Inquiry Date:
2/21/2012
DL/ID #:
459AF2353 (IA)
Name:
Abdalla, Jalaleldin
Class:
D
CDL Med
Rahemtalla
Status:
Iowa Department of Transportation
Address:
2525 BARTELT RD APT
Audit #:
5811391
2A
Issue Date:
02/21/2012
City/State:
IOWA CITY, IA
Expiration
04/25/2015
522462718
Date:
Endorsements:
3
Mailing Address:
2525 BARTELT RD APT
Restrictions:
NONE
2A
Date of Birth:
4/25/1974
Mailing City/State: IOWA CITY, IA
Sex:
M
522462718
History Information
CLEAR DRIVING RECORD
Name: Abdalla, Jalaleldin Rahemtalla DL/ID: 459AF2353
Customer #: 5741899
ID Status: None
DL Status:
VAL
CDL Status:
None
CDL Cert
None
Status:
may► ^
CDL Med
None
Status:
Iowa Department of Transportation
Restriction
None
Supplement:
Pursuant to Iowa Code 4321.10, 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:
t•••'•'•�v/�4,
2/21/2012,�,,*ypr
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Office of Driver Services
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Iowa Department of Transportation
Name: Abdalla, Jalaleldin Rahemtalla DL/ID: 459AF2353
Pb. 24. 2012 2:21PM Div of Criminal Investigation No. 5353 P. 2
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Received Time "Fe6. 21. 2012 3:34PM No, 4884