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Home My WebLink About13-279 Authorization Number r 1 (Office Use Only) Or1742141 `z .41. mama oglir APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (Police Department review must be made 410 East Washington Street between 8 a.m.to 3 p.m., Monday—Friday.) Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX Firstnn `/ MiA e Last � �, 1. Name L(., B �"iR 'R( 2. Mailing Address O ict e,�'�'-, iw ( h-"cr Li (L c j Z 3 LI( 3. Telephone: Home 3 )' _ L! / 1' p,\ Other: /� � y 4. Prior experience in transportation of passengers: S — E J ‘ a 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? N 0 Type 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? IV U Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? ni Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Ai'0 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) N 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) clerkftaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number, 23 C C 5 , 2 3 . 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 Q._ /11 Date 1 7 2 / STATE OF IOWA COUNTY OF JOHNSON ) S scribed and sworn to bef9re me by /—t bU- a del S . On this 744 day of �a1A4KELLIE K.Tu-n-LE �� (7-c . JC —Coq o ..{ty Commission Nu ber pzi ry 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). //fit_ Signature f Polb ice 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. / /Z�r .7/ f ' - �� [2-// 7 / Signa re of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/z" (width)and 51/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update • clerWtaxidrivbadgeapp201 o.doc 03/2013 Iowa Department of Transportation 4,1111 ir Office of Diver Services (Ibil Free)80+1332-1121 PO Box 9204,Des Moines,IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 8/20/2013 DL/ID #: 239CC5823 (IA) Customer#: 2657219 Name: Idris,Abubakr A Class: D ID Status: None Address: 1001 N BOSTON WAY Audit#: 6585822 DL Status: VAL Issue Date: 01/03/2013 CDL Status: None City/State: CORALVILLE, IA 522413116 Expiration Date: 01/01/2016 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 1001 N BOSTON WAY Restrictions: NONE Restriction None Date of Birth: 1/1/1972 Supplement: Mailing City/State: CORALVILLE, IA 522413116 Sex: M History Information CLEAR DRIVING RECORD Name: Idris,Abubakr A DL/ID: 239CC5823 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: _ •yq 11 oa. 11;114 8/20/2013 5'0? IOWA 1▪ 1,. i : 'to ceir,;er c3:.D. O.T. eitacta ,'1jit,0RIV*'es-`▪`' OowiaD pf artmer toof ices Transportation Name: Idris,Abubakr A DL/ID: 239CC5823 AriC011. CCA-Aa.. 12 t.) ra 711 KKI■ Oct. 5. 2013 5: 52PM Div of Criminal Investigation No. 8206 PP. L1/1 m G l:1. Li LU !) L.J U I nI C l l y 1,I e l a 1.l l y u I Iowa v i l y N v. J J V V ■ t.talr . STATE OF IOWA >„1rtr,J�, , /!`F\'`: Criminal History Record Check 'r �'s _ ii 1113V14..)02.: S, ,. 1t A. 'AU Request Form DCI Account Number:_ I-)opo-F at-applicable) Tot Iowa Division of criminal Investigation From: OM OF IOWA CITY Support Operations Bureau,r'Floor CITY CLERK-S ONPICE 215 B.7111 Street 410 E WASHINGTON STREET Des Moines,Iowa 50319 (515)725-6066 IOWA CITY 7TAJA-52210 (5x5)725-6090 Fax phone: 3193565041 Fax: 319-356-5497 . I sin requesting en Iowa Criminal HistoixRecord Cheek on: Last Name (mandstorS4 First Name (Mandatory) 1Yliddle Name(recommended) ( i3 Date of Birth(mendalory) Gender(mandatory) Social Security Number (recommended) ” \ \ e(-1 2 • radMale Orem ale Lia 5 291 - 39 $ Waiver Information:Without a signed waiver from the subject of the request,a complete criminal history record may not bo releasable,per Code of Iowa,Chapter 6924.For aomnlete criminal history record information,as allowed by law,always obtain o waiver signature from the subject of the regtlest. Waiver Release:r herebygive permisrlun kr the above rogue-Ong official to conduct an Iowa odminal historyrecord check with iliaDivision of.Criminal Investigation(DC1).Any criminal history doter concerning mo that is maintained by the Delo'ay be released as allowed bylaw. �_ WaiverSignalllre: Lb pi�ll� a Iowa Criminal History Record Check Results (Donee only) As of I C- --15 , a search of the provided name and date of birth revealed: • No Iowa Criminal History Record found with DCI • • 0 Iowa Criminal History Record attached,heDCI# . • DClinitials Vi . n_ _ _ !.. _ I r:__77 _1" 4'I(4ni o ei.nnota M. no in