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HomeMy WebLinkAbout12-218r 1 CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 5224/�0-1826 4Q:3:19) 356-5040 `,jk - MOltjCe - (319) 356-5497 FAX // 1. Name Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) Middle 2. Mailing Address 116 q P '-w y 3. Telephone: Home ` A) 32S-- -ZL/7 Other: 4. Prior experience in transportation of passengers: J�Z —ask (Office Use Only) 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? O Type of offense Where When 6. Have you bean convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years O Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? /JO Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N Cp 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) GetlN idrivbadg 06/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license'humber 9 -TZ f /�� $ 2 �I . 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) Signature of Applicant ,i /J Date—541S.1 12— STATE 2 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by iib a c \ mar On this 3 day of otary Publi in and forthe State Iowa *********RR##*****#*Y*}R#*RR##RR}}#YY#R#RRYYtR#RR*it#Yi#4R}t#tRR***#R#RR*RRRY#RY#RRR*ttY#*R#ttYH**R##RH*t*YYtti#RRRRR}RRi*YY4}t##HHttiiii#4! 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). 'Signatur6'of Police Chief /orr designee Signat of City Clerk or designee Date i-/4-/_I� 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. f4f 114#44ffHfH#444fHH##f#HH##f4##Hff+4HH##H4#####4H###+######4###f##44H#fHH#H+##HH#H!#f4H##H##H##4HH#iH4H##H#R#*#+fe1`ff Office Use Only Approved application DCI report State certified driving record Website update ded mdnwadgea�2010 d« 06/2012 Sep. 12, 2012 10:35AM (Div of Cf•iminal Investigation. STATE OVIOWA t i; ; �au�6agraaZ.J([is>�o yr eeo>rd Check Request Form �i. r • To; Xo�VnlllvinidNdfCrfmivall[i5es[dgaCfah Support Operafidns Suronu,121))roof 2f5E, 7�b SireoE bovlYXy1[Ie9,Xo�Va 50919 (51S) 7254066 (SIS) M-6086 lrarc Lam ABDC-L 'yF}'�1 NNo. 3767 PP. L10 4VVV ^pYYVf.' V u rj nlyl`.r:. a ACIAccovntD7umBer ���� fepylicab c) From: cITY OK' Tom r'-=: CITY 07'MIK" S 0) MR 4Yo r wn..,4kTiYQ7c1N STRII TOLTA OTTP TOWA 52240 FY[nneC yin-•ash-.snkY 1!0x: 4L9--356z5La7 _ NAA fb M p7l©s�/ g � / I nr�,ra b�comaxe � • evW -- 76 — �?o ? bo r6le0enblc, per Code wrrom thasupjcat oftho A•egaesf, a compla 6 arimfnalhistory reeolraninyuot Toro le ecrlmtntilhistoryr'ecordfnfozmnt(on,n3allowedbylpvi,h[(Ynys Fl�lLb�eYl2elelt5E,'Yhcrcbyg[vepermlwfonfbr[hanboveroquesUngohtoint[n oonduo{erlYownodmfnal6ls[atyteeotCeheckWil(�IhebAislonaPerlmina( YnYosdge[[on(pCp. Any en4�)inelhfslotydeW6peCom(rtghtosbnClaMatnrolnod6ythob01may6e[oicatod0.vld(oleo4byGty. Walver.S`lghnl�l`e• J '� r AUPYi11..11JJA111Ci1JLUatLUXV I-XVUEU 11�11VVAASCBUIUY 00Cl two only) Moi_ �--� %� asearchofthapYowdedname anddQtooibirrhx0vealed; `r• ;_; No Yom 0-ilninal ITlstory Record flo>riad with D Cl ' . ; _n ; © lowaG4i[ninalT�isfgzyReeordattaohed,Del# v LO DCX Received Time Sep, 4. 2012 1:26PM No.2641 CX Iowa Department of Transportation Office of Driver Services (Toll Free) IDU -532-1121 PO Box 9204, Des Moines, IA 503DG-92134 515-244-9124 FAX: 515-239-1837 Inquiry Date: 9/5/2012 Name: Abdelrahman, Yasir H Address: 1409 PLUM ST City/State: IOWA CITY, IA 522402121 Mailing Address: 1409 PLUM ST Mailing City/State: IOWA CITY, IA 522402121 Name: Abdelrahman, Yasir H DL/ID: 274AD4829 Certified Abstract of Driving Record DL/ID #: 274AD4829 (IA) Class: D Audit #: 5452048 Issue Date: 08/18/2011 Expiration Date: 07/05/2013 Endorsements: 3 Restrictions: Corrective Lenses Date of Birth: 7/5/1961 Sex: M History Information Customer #: 5437579 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 offlclal 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: """•:;(I'h 9/5/2012 IOWA'¢°'� Office Driver of Services Iowa Department of Transportation Name: Abdelrahman, Yasir H DL/ID: 274AD4829