HomeMy WebLinkAbout12-231CITY OF IOWA CITY
410 East Washington Street
l0 2240-1826
19) 356-504
(319) 356-5497 FAX
Authorization Number /,-�2 —(;?5/
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
(Office Use Only)
First. Middle Last
1. Name IQRtS h6DE1 LATIE J,bijjR*\s
2. Mailing Address 60► we-_STw kril A c 1TX; fA �&a.2skA
3. Telephone: Home Other: t a It jo�j c3 3 2 9
4. Prior experience in transportation of passengers:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? n/o
Type of offense Where When
6. Have you begn convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? u
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? "y o
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /✓o
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)
detl idx vbatlg 06/2012
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license ntmber
547 R 6 50 67 . 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 Date ecz
4####44#4»it4»R44RRRRR*RR»»»f»Y»ff##MYf»YlYY4»iii»»##'ki4#»#»#»#4»##44»44##ii»»4»»»*4R#»IR**RRiflYlRfflf*!1f»Yff»f f ff ik#
STATE OF IOWA )
COUNTY OF JOHNSON
S scribed qnd s orn to before me by �n Sr i S On this 2 COQ day of
_Ln) _, j� �% �/ /,
r°'"1s KELLIEK.TJTrLE I\'e—�-L i'e_ 1� 1 I.LZrt"lSL
�o �L Commission Number 221819 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).
4a
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
cl�b.dg..W2010.tl 06/2012
Iowa Department of Transportation
A— Office of Driver Semces (Toll Free) Boa -532-1121
PO Box 9204, Des Maines, lA'5d)3U6-92114 515-244-9124
FAK:515-239-1837
Inquiry Date: 9/7/2012
Name: Idris, Idris Abdellatif
Address: 601 WESTWINDS DR
City/State: IOWA CITY, IA 522462755
Mailing Address: 601 WESTWINDS DR
Mailing City/State: IOWA CITY, IA 522462755
Na.nne: Idris, Idris Abdellatif DL/ID: 547AG5067
Certified Abstract of Driving Record
DL/ID #:
547AGS067 (IA)
Customer #:
Class:
B
ID Status:
Audit #:
5714153
DL Status:
Issue Date:
12/30/2011
CDL Status:
Expiration Date:
03/24/2016
CDL Cert Status:
Endorsements:
PS
CDL Med Status:
Restrictions:
Corrective Lenses
Restriction
Date of Birth:
3/24/1956
Supplement:
Sex:
M
History Information
CLEAR DRIVING RECORD
5872807
None
VAL
VAL
Excepted Interstate
None
None
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:
N: ""' .`���i �p
9/7/2012
IOWA *7.
D. 0.T..c:��%
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Office of Driver Services
ORIYEN
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Iowa Department of Transportation
Name: Idris, Idris Abdellatif DL/ID: 547AG5067
Sep.24. 2012 10:41AM
1) W. I[. [u II 11:1DAM
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Div of Criminal Investigation No. 5771 P. 2/4
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be ro(oaeub(o, pct Codo eeY611% chapter692x, Y7or somufota er/mtnalhtetory raoozd lnfotmntfoh, as allowed 5y Ialrir affrays
�!L!I/CY.liCiE(L$'/f,� (IlorcbygTVo permisslon Lbrehoaboverequulrng o!((oiel ro rottducl ¢nYowa crlm/naI hlsmryceceM rhea(LYiih IheDirislon OY'Giminal
r4V01i9errod(M)• Ally crinlfeaUih(otydnMCOneemingmolharJsmalnielnedb�lhol]0lmeyborc(eesodasnlfowcdbytAw.
As of %/ a aeavh Oglo pioVlded name and data o�b4rthseVealedc
NO Yowa Critninal lTistory kecord >eobnd witli D CI
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Received Time Sep.12. 2012 11:00AM No.3710
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IDRIS ABDELLATIF
601 WESTWINDS DR
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DL N. 547AG5067
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