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CITY OF IOWA CITY
410 East Washington Street
Iowa Ci a 52240-�1826
31 ) 356-504_0 /�nJOK ��77
356-5497 FAX
Authorization Number 1,2 - j g'15
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
First Middle Last
-�
1. NameENA--o
2. Mailing Address So/ V sr .74 VE - )Pe _
3. Telephone: Home 031q) GI36— 6356 Other:.
4. Prior experience in transportation of passengers: tq C� adw al
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? J
Type of offense Where When
6. Have you been convicted onvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? //V�
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? N0
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? NO
TVDe 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 ANDSTAIEOERTIF
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR P CE 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)
der to idrivbadg 09/2012
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
�60A A �2 // . 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) iakA
Signature of Applicant Date
STATE OF IOWA )
COUNTY OF JOHNSON )
bscribed and sworn to before me by Ii ze4z . On this this day of
'7K
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).
aAo"
Sig ture of of a 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.
Sigrtature of City Clerk or designee
Taxi cab businesses are required to provide Driver Identification cards.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
42 ' a / - / Q.
Date ya3-LS
nanmaaddwadg.pp2010.a 09/2012
Dec^14. 2012. 2:OOPM Div of Criminal Investigations
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Received-T'ine%(bei; 1, 2012 9:46AM No. 759
Page 1 of 1
Iowa Department of Transportation
►I, Office of Driver Services (Toll Free) WO -532-1121
PO Box 9204, Des Moines, fA 503D15-92134 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
12/19/2012
DL/ID #:
960AA9211 (IA)
Customer #:
1304473
Name:
Dizdar, Senad
Class:
D
ID Status:
None
Address:
501 21ST AVENUE PL
Audit #:
3296593
DL Status:
VAL
Issue Date:
05/12/2009
CDL Status:
None
City/State:
CORALVILLE, IA
Expiration
03/05/2014
CDL Cert
None
522411435
Date:
Status:
Endorsements:
3
CDL Med
None
Status:
Mailing Address:
501 21ST AVENUE PL
Restrictions:
Corrective Lenses
Restriction
None
Date of Birth:
3/5/1956
Supplement:
Mailing City/State:
CORALVILLE, IA
Sex:
M
522411435
History Information
Convictions
Citation Date Conviction Date ACD Explanation County JUR
05/08/2008 '06/03/2008 S92 Speed 52 IA
Name: Dizdar, Senad DL/ID: 960AA9211
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:
••:��/°V
12/19/2012
IOWA %w,
). 0. T.6
........•S
Office of Driver Services
tilla—
Iowa Department of Transportation
Name: Dizdar, Senad DL/ID: 960AA9211
12/19/2012