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HomeMy WebLinkAbout12-100First Middle Sh L. DV Last SAL L u F 1. Name I�'�i}{111}f�C V I 2. Mailing Address 30 MUC(,A,vim AI% ibtUKF c'IM1 Lp S; it4o 3. Telephone: Home JAS 1 g1; 3 3 Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? VC) Type of offense 49) 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? nro Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? wo Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? A/0 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 STATELERIWIED DRIVING RECORD MUST ACCOMPANY THi3 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) derkPa idrlvbadg 09/2010 Authorization Number 12 --loo r 1 (Office Use Only) ® 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 Cit ,Iowa 52240-1826 5�1U 9 56740 I (319 7 FAX First Middle Sh L. DV Last SAL L u F 1. Name I�'�i}{111}f�C V I 2. Mailing Address 30 MUC(,A,vim AI% ibtUKF c'IM1 Lp S; it4o 3. Telephone: Home JAS 1 g1; 3 3 Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? VC) Type of offense 49) 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? nro Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? wo Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? A/0 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 STATELERIWIED DRIVING RECORD MUST ACCOMPANY THi3 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) derkPa idrlvbadg 09/2010 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 3 (, R ✓ I 13 I understano 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) I' y —� Signature of Applicant A a"ta r1 / Date 1 1� #R*R#R***#R*##**R#fff*flRlfff#ffffffMf!#ff##f!f*f1f#fflkfRR#fftlRff*f*kffRHR*R*f####*f*f#fY#*ff##YN#fff#fflfff#fflffRRHif#***FRR######f#1f#* STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and worn to before me by I OJKa_d o t &L.L de_ On this day of Z Jaw KELLIE K. TUTTLE J (1.� 1 commc m� IS°m�F 6619Votary Public in and for theState of Iowa ow #4##R#4#R4M#4#44RRRRXR*M*X#R*kM*XR{k*kM**XR*M**R*R* R*RX*R*RMX4{*4Rki#4##R{441#44*4i*4#4#**44#tY*****t**k**kM*RRkR**X{X{*X*44*41444#t**44#t##*44 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 Pol a )hiie or deesignee j y� - `T Signa re of City Clerk or designee S-/'/ /a Date 5�/-/-/3_� Date After Police Chief and City Clerk have approved authorized tax driver names will be placed on the city website at icgov.org. Taxi cab businesses are required to provide Driver Identifi.,.ation cards. Office L se Only Approved application DCI report State certified driving record Website update deM=idnv adgeaM2010.d 09/2010 , I At Iowa Department of Transportation Office of Driver Services (Toll Free) WO -532-4121 PO Box 9204, Des Moines, 1A 50306-9204 515-244-9124 FAX: 515-239-1837 Inquiry Date: 5/12/2012 Name: Balde, Mamadou Saliou Address: 2430 MUSCATINE AVE APT 37 City/State: IOWA CITY, IA 522406653 Mailing Address: 2430 MUSCATINE AVE APT 37 Mailing City/State: IOWA CITY, IA 522406653 Certified Abstract of Driving Record DL/ID #: 596AH1382(IA) Class: D Audit #: 5961382 Issue Date: 05/04/2012 Expiration Date: 05/09/2017 Endorsements: 3 Restrictions: NONE Date of Birth: 5/9/1967 Sex: M History Information CLEAR DRIVING RECORD Name: Balde, Mamadou Saliou DL/ID: 596AH1382 Customer #: 5948346 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: 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: ........ ;7i��y 5/12/2012 IOWAlleorgc :y°s D. O. T..-.- op Office of Driver Services Office y"RRIVER,; Iowa Department of Transportatlon Name: Balde, Mamadou Saliou DL/ID: 596AH1382 May. 11. 2012 1:39M Div of Criminal Investigationy iNo:4506 P. 3/3 . 'I'o; xo)Vab(v7s1o11ofcrhn9naIYnYe9llgorlon 5oppoYt Qparandns A4Coau,1'L Flaor a;(6�.1'n S(reaC b�ah[gines,Tolva X0319 (sis)72s-bo66 (613)129-6000 vat n Check mF(6`i51F Requost Form 13C1AuoouatXbtnber; 0cQ — Otoppllvmd) From) (i['M, OF TOTY"A 01W CITY C1UX's wmic'3 4.Y9�TLA s x OI7 FsT I IOVA. 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