HomeMy WebLinkAbout12-164-4
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CITY OF IOWA CITY
410 East Washington Street
Iowa Cil Iowa 52240-1826
0-1 9p 3S6-50 Mor 8/F'
(319) 356-5497 FAX
First .
1. Name /15&L
2. Mailing Address 164-2
3. Telephone: Home
4. Prior experience in transportation of passengers:
Authorization Number \a-\bL\
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday - Friday.)
Middle A 0- Last
j"70ther. 3/ —
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? NO
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? uo
Type of Offense
Where
When
7. Have you been convicted of any traffic offenses in the last five years? O t.C- kt aw , Coee_d;s4-4
Type of offense Where When
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8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? "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 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)
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I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
% %5 Z 2 6 3 2 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) -1
Signature of Applicant %f—/ Date
*f*R*Y**Y######4#######*****R*1f***Yf*#########4*4***R****R4*Rf**11Rf#R1111RYf1fY1f1f1f1##4###M##h#########**##R#RR*RRR1Rf*Yf*f##1f############
STATE OF IOWA )
COUNTY OF JOHNSON 1
,,ubscribed and sworn to before me by _k s r„Q Z-Nng-\ On this 3 day of
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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).
/l'#fr:� /-T
Date
Date
NOT VALID UNTIL Police Chief and CityClerk have approved and authorized taxi driver names placed on the citywebsite 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
derwla idmCadgeaW201 0 d 09/2010
Aug'
8. 2012
2:52PM
Div of Criminal Investigation
No.7964
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Iowa. Criminal MsfwjRecord. attach
ed, DCT#
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Received Time Aug. 3. 2012 8:25ANI No. 0735
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Iowa Department of Transportation
Office of Ddwr Services (Toll Free) BM -532-1121
PO Box 9204, Des Moines, IA 503069204 515-244-9124
140 FAX: 515-239-1837
Inquiry Date: 8/2/2012
Mohamed Bakheit, Ismail
�. 1642 ABER AVE
•y/State: IOWA CITY, IA 522464709
Mailing Address: 1642 ABER AVE
Mailing City/State: IOWA CIN, IA 522464709
Convictions
Certified Abstract of Driving Record
DL/ID #: 775ZZ6832(IA)
Class: D
Audit #: 6177168
Issue Date: 08/02/2012
Expiration Date: 07/04/2014
Endorsements: 3
Restrictions: NONE
Date of Birth: 7/4/1959
Sex: M
History Information
Customer #:
3874967
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 3UR
06/04/2009 09/04/2009 S92 Speed 52 IA
Name: Mohamed Bakheit, Ismail DL/ID: 775ZZ6832
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.
—ess whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date:
• �`''4
8/2/2012
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Office of Driver Services
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Iowa Department of Transportation
Name: Mohamed Bakheit, Ismail DL/ID: 775ZZ6832