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CITY OF IOWA CITY
410 Eas[ ashington Street
owa City. Iowa 240-1826
Q 191 356-5040
19) 356-5 AX
1 1. Name First
2. Mailing Address
Authorization Number L-_� -a0 t,0
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
Last
3. Telephone: Home Other:
4. Prior experience in transportation of passengers: LavL <;
GV) <:,qU vs6!5co TX\ CigL> Frtr -r-hvee. RA K<
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 been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? � ��
Type of Offense
Where
7. Have you been convicted of any traffic offenses in the last five years? PT
Type of offense
Where
When
When
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 bean 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)
uarlNaxitlnWatlg 06/2012
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
s w 7Aa 926 d . 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) r�
Signature of Applicant DateL—
F+f**+#**##**M*F**f *f*f***f**f #*4f HfiH*Yf*fYf11f f4fYY*1f*f fYf*f 1HH#if*4Yff41f if4f##4fHHH11fYYf4H11HM4H11M44####H#Hi#fif####+4+#H
STATE OF IOWA )
COUNTYOFJOHNSON ) /
scribed and sworn to before me by I r ' u-iyhs i Y A - L) ) On this ✓ \ day of
I.'-.)—
o� a KELLIE K. TUTTLE Nota Public in and for the State of Iowa
® f• CnmmiexinE Number 221819 Notary
MyppnJnwi p,Eq fires
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).
or
of City Clerk or designee
42.
Date
-/02 -
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#HHRfRRRfHHHHf4HH44f!#f�Fffif!!H4#H#Hf#fif##1HH+4#####k}fff*}H#*HH#H}}H#}Hf##f**#f}HRHR*##RR*#}}R*#RR#fR#Rff fRff
Office Use Only
Approved application
DCI report
State certified driving record
Website update
d.n .,dnvb g.WplG. 06/2012
Iowa Department of Transportation
Office of Driver Services (Toll Free) 800-532-1121
PO Box 9204, Des Moines, IA 50306-9204 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 9/5/2012
Name:
All, Muntasir Hassan
Address:
2411 BARTELT RD APT
D. 0. T.
2B
City/State:
IOWA CITY, IA
DRIIIEN,--
522462706
DL/ID #: 547AG9268 (IA)
Class: D
Audit #: 5511711
Issue Date: 09/15/2011
Expiration 06/07/2016
Date:
Endorsements: 3
Mailing Address: 2411 BARTELT RD APT Restrictions: NONE
2B Date of Birth: 6/7/1978
Mailing City/State: IOWA CITY, IA Sex: M
522462706
History Information
CLEAR DRIVING RECORD
Name: All, Muntasir Hassan DL/ID: 547AG9268
Customer #: 5871648
ID Status: None
DL Status: VAL
CDL Status: None
CDL Cert None
Status:
CDL Med None
Status:
Restriction None
Supplement:
Pursuant to Iowa Code 4321.10, 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:
s: •""••:�'iJ�y
9/5/2012
IOWA
D. 0. T.
9p......•' $ =
Office of Driver Services
DRIIIEN,--
Iowa Department of Transportation
Name: All, Muntasir Hassan DL/ID: 547AG9268
SeP.i1. 2012 11 :1 Div of Criminal Investigation
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Received Time Aug. 30, 2012 4:09PM 'No. 2548
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