HomeMy WebLinkAbout12-138r Authorization Number I oL `/3 Z
1 (Office Use Only)
APPLICATION FOR TAXI DRIVER
CITY OF IOWA CITY (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
(3 19) 356-5040
(319) 356-5497 FAX
First Middle Last
1. Name Elt'nsjwd _y t4c4 t E15 11�A
2. Mailing Address QS:: I L.( N(o cSSY G l e » C-4- kc,/C4 r'4 i)a 5 22 t -f 6
3. Telephone: Home Other: 3/Ci Fj t S' 9 S t
4. Prior experience in transportation of passengers:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? A10
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? /l/0
Type of Offense
Where
When
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where When
8. Has your drivel'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)
cler�.,d,ivbatlg tt9/2440
(�bIzoIZ
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license nunftr
I understand that if 1 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 Date// 12
STATE OF IOWA )
COUNTY OF JOHNSON )
ibed and sworn to before me by �� rA S �i r� f On this o:-'+ ' D-day of
'I `fir KELLIE K. TUTTLE � J
o i Commission Number 221 at 9
My Cem i_�orlE�?- N tary Public in and for the State of Iowa
****#*Y**f##*i#tf##t#Y4111R*M****iit4i#4i#44*Ri#Rf44Rf}1R}******##R1#**f*ff#ti#ttii#tfiflN}1Rf}RRRR}1R}RR}M*#***f#*ff#*f*Yi#fifi4f#RBBB}Rk**#*R
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).
S4ignAurB
ur o c hleFor designee
of City Clerk or designee
7-02 1-H/
Date
Date
NOT VALID UNTIL Police Chief and City Clerk have approved and authorized taxi driver names 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
derWtax&vm geapp201 n doc 09/2040
" I2U 1'L_
Iowa Department of Transportation
�/ Office of Driver Services (Toll Free) 800332-1121
PO Box 9204, Des Manes, IA 593D0-9204 515-244-9124
FAX: 515-239-1837
Inquiry Date: 7/12/2012
Name: Elsid, Elrashld
Address: 2514 MOSSY GLEN Cr
City/State: IOWA CITY, IA 522464108
Mailing Address: 2514 MOSSY GLEN Cr
Mailing City/State: IOWA CITY, IA 522464108
Convictions
Certified Abstract of Driving Record
DL/ID #: 122AC6636 (IA)
Class: D
Audit #: 5867668
Issue Date: 03/20/2012
Expiration Date: 08/16/2014
Endorsements: 3
Restrictions: NONE
Date of Birth: 8/16/1968
Sex: M
History Information
Customer #:
4319145
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
Citation Date Conviction Date ACD Explanation County JUR
03/25/2011 04/11/2011 S92 Speed 52 IA
Name: Elsid, Elrashid DL/ID: 122AC6636
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:
;- •:;v/'4
7/12/2012
IOWA
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Office Driver Services
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Iowa Department of Transportation
Name: Elsid, Elrashid DL/ID: 122AC6636
Jul. 12. 2012 4:14PM Div of Criminal Investigation
Jul. 10. 2012 11:510 City Clerk — City of lova city
r
STATE OF IOWA
Criminal History Record Check
RequestForm
To: Iowa Div[ston of Crlminnl Investigation
Support operations Buroau, VFloor
215E 7o'Street
AesMoihes,Iowa 50319
(515) 725-6066
.(516)725.60®0 FQ9
No. 3397 P. 1/1
No. MI P. ui
DOIA000untNumber: 1 W�
(IPappiimbla)
Yrom: CXTX OT IOWA. CJTY
CITY CLERIC'S OFFICE
410)9, WASW Nt'rTONSTABET
IOWA CITY IOWA 52240
Phone: 319,356-5041
Fax: 319-3565497
xowa Criminal I CDOTMa o„ty)
As of 4 r a - l i , a search of the provided name and date of birth revealed:
EA No Iowa Criminal History Record found with DCI
® Iowa Criminal Mstoly Record attached, DCI
ACliniti0ls.
RPr.aived T1me7'JuI. 10.- 2012 11:45AM No, 2702
r.�