HomeMy WebLinkAbout12-222�r y��®li��
CITY OF IOWA CITY
410 East Washington Street
Iowa City. Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
1. Name
2. Mailing
3. Telephl
Authorization Number 14 —aA a
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
4. Prior experience in transportation of passengers: till C)
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense
Where When
6. Have you en convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? A.10
Type of Offense
Where When
7. Have you been convicted of any traffic offenses in the last five years?
When
20%(3
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /)/D
Tvoe 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)
clerwt drivbadg 09/2012
I hereby c7,*. t I hav issued to me by the Iowa Department of Transportation a valid Chauffeur's license number`
413 22 . 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) A 7
Signature of Applicant Date / - )o — 1,2
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STATE OF IOWA
COUNTY OF JOHNSON
S scribed ands orn to before me by Mu0 Z A b J I"0_L)%o On this ��' " day of
a2— KELLIE K. TUTTLE a#a
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).
Sigfi5t6re c olice Chief or designee
Date
YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY
CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org.
Ai��14--l.�
Signbture of City Clerk or designee
Taxi cab businesses are required to provide Driver Identification cards.
Date
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Office Use Only
Approved application
DCI report
State certified driving record
Website update
derkRaxidri badgeappWl 0 d 09/2012
Iowa Department of Transportation
N r a
Office of Driver Services (foil Free) B06332-1421
PO Box 9204, Des Moines, IA 5i]30&92G4 515-244-1127
FAX: 515-239-1837
Inquiry Date:
9/20/2012
Name:
Abdrabbo, Muaz Salah
CDL Cert Status:
Abdulla
Address:
2601 LAKESIDE DR APT 9
City/State: IOWA CITY, IA 522406816
Mailing Address: 2601 LAKESIDE DR APT 9
Mailing City/State: IOWA CITY, IA 522406816
Certified Abstract of Driving Record
DL/ID #: 618AH3129 (IA)
Class: D
Audit #: 6315715
Issue Date: 09/20/2012
Expiration Date: 01/01/2017
Endorsements: 3
Restrictions: NONE
Date of Birth: 1/1/1985
Sex: M
History Information
CLEAR DRIVING RECORD
Name: Abdrabbo, Muaz Salah Abdulla DL/ID: 618AH3129
Customer #: 5996818
ID Status: None
DL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
Iowa Department of Transportation
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:
....
9/20/2012
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Office of Driver Services
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Iowa Department of Transportation
Name: Abdrabbo, Muaz Salah Abdulla DL/ID: 618AH3129
State of Iowa
Division of Criminal Investigation
215E7"'St
Des Moines IA 50319
Ph. 515-725-6066 Fax 515-725-6080
Iowa Criminal History Record Check
Walk -In Request
Your name A {a
Address
City/State/zip
Phone#
Requesting an Iowa criminal history record check on:
Fill in all shaded areas.
Last Name(mandatory)
First Name Prinver Nombre (mandatory)
Middle Name Segundo Nombre (recommended)
�A1p�ellido
A�L6 �W%b
Vili�
,sq�all A' u
Date of Birth FechoNacinvienro (mandatory)
Gender Genero (mandatory)
Social Security Number (recommended)
cd —0I ~I l�5
CNale ❑Female
07-53Z/�
Waiver Signature Firma (If the request is on yourself, please sign. If the request is on someone else, write N/A.)
ResultsQ
nct use MY
As of [ pcUZ a name and date of birth check revealed:
-
-- —
No record found
r'.
CQ
rn
-a
O
El Record attached, DCI #
-
DCI initials �/
me
Receipt
Number of requests x $15.00 per last name = Total amount $ j 5 • d C�
Method of payment: 19cash ❑money order ❑check # []MasterCard or Visa
Cardholder's name
DCI
Last 4 digits of MC or Visa
Credit Card Number # Exp. Date