HomeMy WebLinkAbout13-271 Authorization Number
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CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER
(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
Middle t ` Lat1. Name
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2. MailingAddress
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3. Telephone: Home 2)c- 1 ? — etc S 7 I Other:
4. Prior experience in transportation of passengers:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Al 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? / '
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? > L,
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ./P6
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).
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
cierk/taxidrivbadg 03/2013
1
I h reby c rtify that I ve i su d. to me by the Iowa Department of Transportation a valid Chauffeur's license number
La de{/ 71f'yt �t.4,1p (�), I understand that if I falsely answer any questions in this application, that this
application maybe deni 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 1i-- 2 7- 2 I
************.....**.....,.* .....t.....:t***** **:t:t****** ******** ...,t**f t *tea.,.. ..... ..........** *.*.***********.*.**..***********.* *
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by f�bele/42 I/'r A. / b 1 l`i r I`. On this 7 day of
�� La /�'
�,.'>� it---) Y.
A - C'4--)' i'
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).
ad /A-02 7-/y
Si• ature • ',rice 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.
71 L 1-4---1-4----''L,eg _ /� X-'I/✓ // 7 /_J
Signature of City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 51/2"
(height)and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
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clerk/taxidrivbadgeapp2010.doc 03/2013
Nov, 25. 2,01/4,1,3J3 1 :42PM Div of Criminal Investigation No, 6253 P. 1
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nii'l7ii• .. STATE OF IfO A I`lpin,, r
<ro v1 ',), . Criminal History Record Check :: :fi:.'.N.•
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Dal A•coountNumb er: Voo j.4 ,
(fCapplleable)
To: IoW4711vfifon of Crtm:nal luvestigntlon Erol' OTOit or I017A. CITY
support ODeratlohsaureavr,I"noor 'biTY 01,11RK's OFFICE
215 E,7v'Sire et ASO S WASftflGLON 6TR$$T
Ties Manes,Wen 50319
(515)129-6066
(515)725.6080 14ut
Pllmla: 319-3565041
Fax; 319-356-5497
atnroquast;ng an Yoga Criminal History RecordChooi<on
Lot Name Imuidaforo YilrstNnmo(mndAoro) MlddleNatne(recommended)
ate of Birth(mand.tor))ire Gender Councillors.) Soelal Security Num13er(rueg.mon4ed)
f-lam513 - aiMplo ❑FomaYe QM-I-93 — ti—e) D 6
Waft/or Piranha/loft:Without n sighed waiver from rho iubJeot of the request,n complete°rlrhinal historyrecord mny not
be releasable/per Code of Iota, Chapter 6922.Mr comuloto orIminalhistory record Infornlation,no allowed by law,atsvays
obtain a wn(vor sign a(fro kohl fhesnblect of the rotted;
Waiverltefenye;ihorebyeglvd pemission 1bnhe above requwOngo01olel(o coedoµanTame camtnslhaleryttoosd ahuckwith INIllidilon of c,iminer
1nyalip(Ion(DCI). Ary mtmini1 hhlory data oenodmrngmo that lemAddeo e 6y the Delmay 6o ralowed eY arrowed byleW
WaiverSigualure, , , e,!� _ , ,A,i•
Iowa C1aminoi Ih11story Recor4 Check Resets (Derure only)
As of I 1 --d.15 -is , a aearoh of(ho provided name and date of bilihrevealedi
bkNo Iowa,Criminal History Record foundwithDa
El Iowa Criminal llistoryRecord attached,DC1 ••
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DCIInitials l l .
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RFe(ieiveadlimei,Nayv°•115:u93ii3 14iurroM n -1431192
Or Iowa Department of Transportation
c83 Office of()vwe Services (Tal Free)800-53,2-1121
PO Box 9204,des Manes, LA 50306 92D4 515-244-9124
IIIIIP FAX 515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 11/27/2013 DL/ID#: 638AH7950(IA) Customer#: 6027552
Name: Babikir,Abdelazim Class: D ID Status: None
Abdelrahman
Address: 5641 KIRKWOOD Audit#: 7514025 DL Status: VAL
BLVD SW APT 3
Issue Date: 11/08/2013 CDL Status: None
City/State: CEDAR RAPIDS, IA Expiration Date: 01/01/2017 CDL Cert Status: None
524045282
Endorsements: 2 CDL Med Status: None
Mailing Address: 5641 KIRKWOOD Restrictions: NONE Restriction None
BLVD SW APT 3 Supplement:
Date of Birth: 1/1/1958
Mailing CEDAR RAPIDS, IA Sex: M
City/State: 524045282
History Information
CLEAR DRIVING RECORD
Name: Babikir,Abdelazim Abdelrahman DL/ID: 638AH7950
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:
.0...‘rtirctiNtii. 11/27/2013
- D. O. T.
hoi•......0 ) C:1141." Eiglitligg°144
�' Office of Driver Services
Iowa Department of Transporation
Name: Babikir,Abdelazim Abdelrahman DL/ID:638AH7950