HomeMy WebLinkAbout12-1627kr""III-
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CITY OF IOWA CITY
410 East Washington Street
Iowa 52240-1826
56'--5040 t 64 �k
(319) 356-5497 FAX
1. Name
Authorization Number /11� — Flo �;)__
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
Last
2. Mailing Address IeD 4 1 .4 V E CoY A'i III LL � A 9�7 /TO
3. Telephone: Home ,37 — 14o7g Other:
4. Prior experience in transportation of passengers: 14 tI� A Ln - d-
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense
j
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
O
Where
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense
kj J
Where
When
When
8. Has your drivels 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 CERTIFIE=_
_DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POUCE HIEF 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)
derW id,!vWdg 09/2010
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license numbeh
F St /�G 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 16wa 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 O 20 2
###FFRFFRR*RHRRRRRffYff#Y#####H#R#*MRRRHRF*RR+1Rff 1R*Hf#Y##Y#####1f#H#{###i##{R***R*****Rt*RH*RRHRR*FRRHHRfHYHH4HH#f #####H*##*{*F
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and swom to before me by�us',Y E—\c ry l:4w � On this �vitday of
and for the
-71
kf1f11ff*#H**#***#***R*fk#1fHltllff#k#####*4**k**kk#RRkkiklf*fffk#ffkffflffflkfff4f14414##f*k4*************F*#R*R*R*Rk*RfklffkH*Miffff4f Yf##
1 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).
Signature of Police Chi designee
gna ur& of City Clerk or designee
/D 0/
Date
- /o
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.
f H**+**f ***HH*ff1fHYH11H*#++***k****f*f f*ff1fHHHff++Y#4H++H+#++*++*+F*#F****f*fHH*H*HHf1H1f41Hii **H*#H***+*k*fH*fff*fH*Hf
Office Use Only
Approved application
DCI report ✓
State certified driving record ✓
Website update t�
dedv mddvbadgeaW2010.do 09/2010
Aug.
9.
2012
4:17PM
Au g.
3.
2012
12:35PM
Div of Criminal Investigation
City Clerk - City of Iowa City
STATE OF IOWA
Criminal History Recolyd Check
Request Form
To: Town Division of Criminal lnvestlgatlon
SnpportOperatlansBureau, l"Floor
215 E,
7"' Street
Des Moines, Iowa 50319
(515) 725-6066
(515)7ZS-6090 Fax
S K�
No.8240 P. 6/30
No. 2669 P. 3
DCIAoeountNumber: qw;a_—
(if applicable)
From: CITY OF IOWA CITY
CITY CLE RX'S OFffCE
410.U, WASHINGTON STP ELvT
IOWA CITY YOMrA 62240
Phone; 319-356-5041
.Fax: 3193565497
I eln I-C9110stigg an IGWa. Criminal History Record Cheek oil:
UAName endalory) BlrstName(mandelo) Middle Name recommended)
(-fAM I- AMI ry
Date of Birth mondelory)
t'ULdel' mandatory
Social SecurityNnufber
recommcndcd
walyarinjorifla110h. Without a signed W111yevfrom tile, subject oftherequest, acomplete criminal historyrecord maynot
bo reloamble, per Code oflowa, Chapfer 692.2. For om tete crlminol historyrecord Informafioll, as allowed bylaw, always
L014011awalverai gatirefromtileSubtectofthereouest.
Waiver Aeler[Se; T hcrobygivo pcmlisslon for Iho abovo requesdog official to conduct m, Iowa criminal hhtory wcord chcck wish (hcblvlslon orCriminal
Invasligallon(DC. Anyahhlnal history dole eonoMing mo 1110th molnlalned by lho DCtntaybe released as allowed bylaw.
Waiver
Lowa Criminal History Record Check Results
As of 0 — q 1) , a search of the provided name and data of butte revealed:
No Iowa Criminal Histov Record found With D CI
11 Toura Criminal history Record attached, DCI #
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Iowa Department of Transportation
Office of Driver Services (Toll Free) ON -532-1121
PO Box 9204, Des Moines, ]A 5030&9204 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
8/3/2012
DL/ID #:
568AG3736 (IA)
Name:
Babekir Hamid, Yasir Elamin
Class:
D
Address:
106 1ST AVE
Audit #:
5852271
Restriction
None
Issue Date:
03/13/2012
City/State:
CORALVILLE, IA 522412602
Expiration Date:
07/18/2016
Endorsements:
2
Mailing Address:
106 1ST AVE
Restrictions:
Corrective Lenses
Date of Birth:
7/18/1958
Mailing City/State:
CORALVILLE, IA 522412602
Sex:
M
History Information
CLEAR DRIVING RECORD
Name: Babeklr Hamid, Yasir Elamin DL/ID: 568AG3736
Customer #:
5906602
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:
•::v/'4
8/3/2012
10 WA
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..... S`c==r
=OK4V O"A
Office of Driver Services
Iowa Department of Transportation
Name: Babeklr Hamid, Yasir Elamin DL/ID: 568AG3736