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HomeMy WebLinkAbout12-191Authorization Number / 9- / r 1 (Office Use Only) lilt 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 Cit Iowa 52240-I8 6 /, 356-5040 IcgeS (319) 356-5497 FAX N iirst4MidlebCp1Las 1. Name��Ky�V�- - 1 -- 1 2. Mailing Address 5"C)q \D S`1 Cc)�0.\y VE OWG F2Z2 3. Telephone: Home ),LAZU 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? Tvpe of offense Where When 6. Have you 4een convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? l/ e T e of offense Where When SQee ('0c'C",l�ef L� \0(3©1201(2 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) 00 DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND JATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POL1t� F REVI 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) d.rM.idnwbadg 06/2012 I hereby certify tthe Iowa Department of Transportation a valid Chauffeur's license number (6� A.� hat have issued to me by . 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 A 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 V`120 12 STATE OF IOWA ) COUNTY OF JOHNSON ) SAScribed and swom to before me by + 1 kaXvQe-0( On this " ` day of uTTIE ber 221919 Notary Public in and for the State of Iowa 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). u SignSture of Police ' or designee Signature i��L/L�iGs�/ �•�1'A�� Signa of City Clerk or designee 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. Office Use Only Approved application DCI report State certified driving record Website update de�nm d�pp2010.d. 06/2012 Iowa Department of Transportation Office of driver Services (Toll Free) OM -532-1121 PO Box 9204, Des Moines, fA 5030&9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 8/28/2012 DL/ID #: 168AC6018 (IA) Name: Ahamed, Ahamed Abdalaziz Class: D Address: 809 HUGHES ST Audit #: 6241953 Restriction None Issue Date: 08/23/2012 City/State: CORALVILLE, IA 522412143 Expiration Date: 11/29/2017 Endorsements: 3 Mailing Address: 809 HUGHES ST Restrictions: Corrective Lenses Date of Birth: 11/29/1993 Mailing City/State: CORALVILLE, IA 522412143 Sex: M History Information Convictions Customer #: 5302787 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 IUR _ _ ........._....... .__... _..__ ................. ..._, __.. .. _. 10/30/2010 X11/23/2010 592 Speed 52 iIA Name: Ahamed, Ahamed Abdalazlz DL/ID: 16BAC6018 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: ?: ••"•••:;%4h 8/28/2012 IOWA• *''4 D. 0. T. 6i C441V acc�4 7f'•••••'•$_ Office Driver Services of '1 Iowa Department of Transportation Name: Ahamed, Ahamed Abdalaziz DL/ID: 168AC6018 Aug.30. 2012 12:30PM Div of Criminal InvestigationY _ .. a �j�tIY1P pf STATE OF IOWA A Ad ary Re, 111: check �Grfpll0lJ-1 ILUN i� 1\' ' I I 1 ' To. Iowa btvlsfon of Crimina1Xhvartfgetron Support Opefatlons Hurt4% O Poor 216 E. 714 stroot bouN oinos,Iowa 5o319 (91.) 729.6066 (615) 725-6080 )Fa -k Last Pat Criminal 1No; 1962 iP. 2/2Ll L I)CTAccountNhmher: ��.---� Qfgppl(cpble) BYaini Cm of TOry'A crTr CITY CLERK'S OFFIM �. .-410 R,_iaASHTNCTON S32RET IOWA CITY Top K72&• phonb; X919-356--5041 Pax1 319-356-5497 Cheok on; 2P� j 1 cic� 3 I UGlale ' C( emale Xr;/orsllaPio)ti, Without 0 signal li'AZ<'ot'lYatn thesubjett orifc Yap able, 13 or Coh a9Xo1yq, Chapter 692 2, IPor cotnpl9(p cYfmtnalbistory �lifY2)'.�CBr&(ISE;YLtteby®fVepormiss(onCor111oaheyate ashlrggRTellto rnvestlgallon(OCD.,�ulytdminelltlstotyAaladbrcceming gtlam / et ea5 u Walver.S�'g)fnfuY'e; k C1.7 1 b8G� a complbto urN(nal history record ntay not ordlnforroatlon, asallowed bY(aVi, gltYays • by my. As of a seuch of the provided name and data of blA.Yovealed: xl-� No Tbwa Cxi,xyInal912tovIz000rd round with 1)CT ❑ rows Crlmfnal Hfifory Rocord attached, i7Cr# )DCXi4iHals_ Received Time Aug.26. 2012 11:29AM No.2267 (not usoonly) y r., c trj r;. r;J -Cl F:xf r r L cx�