HomeMy WebLinkAbout13-269 Authorization Number / —02, i _CL9
(Office Use Only)
,t ime tsa
CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER
(Police Department review must be made
4 1 0 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
First �-� 1 Middle Last
1 .Name 6 [--0-1 C' �t v 1 c h 4 v fid-4 �,.� 4
2. Mailing Address 7 C Y' �- N 2 C a w C I'+ K rj 2 2 4 6
3. Telephone: Home Other: C ° ' 3\ `1 `c -T G 11 G 5
4. Prior experience in transportation of passengers:
--.477,77-771+177-
5.
c'' `F}t17A'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 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?
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
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)
clerk/taxidrivbadg 03/2013
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
. 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 w Date 1 Z — ��
STATE OF IOWA )
COUNTY OF JOHNSON )
S bscribed and sworn t before me by A kt,� f . oe MAO- . On this a-5 csk day of
kinN) e Ja� yon_
p WENDY S.MAYER Notary Public in for the State o wa
2GeMv C o.ef1 on t 720428
„IlkM Commissss ion Expires
ow •
le,—) t)
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).
__ " • 2s ,3
Signature of Poli - Chigf 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.
742'u�Lu/ k � 1 I t..1 5/13
Signa re of City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width)and 5 1/2"
(height)and prominently displayed to all passengers.
******************************************....************************************************************************************************
Office Use Only
Approved application
DCI report
State certified driving record
Website update
clerk/taxidrivbadgeapp2010.doc 03/2013
LSS£ '°N—NdLO1I —£lOZ— 'S1 AvigzS111!1 Pan aa4
•
J)
.— • rI0a`Pa'PJi Pro7ai410361HPRIM VMMQA CI
•
Ioawns piing prooatrifxozscHvautcm'Mot oR
:•. :pafgOnvrzpatgio oit;.p putt ewgtrpapinvacto•T;o!!Divas S g (�-L k; go w
(.SJuocauU)ir) . ' h7lag@aNOOTO pXQDaa.dxow iearruaua J Aor `7
9A-A-Oj -v s - -
•
�ti =aavu i5 1 ray rDj
7
'Ai vjAg pnwla aaposati ogAduripaGya4plulwutcwrfiNiow9u!ummOo vlvp F4onpfIsIUw91'My'UOo9 uo!m6ps•MOA
• fat/JR/0;0mm mos AAolal9Nu!wpaanw,histolpuoNpiqueAu!InnerienogimMaaJuo!n!win'Imp,fv»VI4,)S7ojp2r,reit viii
1sow` *.alo°fgne,auuuagernpu ' 4'M 4•rtsdxo-
s(tinIu'%%tJA mono ss'uoJpiuuvjuipAooatdaolslgJetgWJa9.nIWho,Agit nurla),{BIO%imp am.t4 xqse9I Qq
Oon,funtpAOOaaho;slgIpo;nIJ.loe;AJ4uto? a<grauppxaq}}o,7oaJ'gnsGIJ1luanai sipo.9avanogJJm. opp=o ,,isrisll14
•
L 6g L 6. joo 4 W ' azaato�;p , 0/, 1' 9 )�\t f ' ► ' 0
0opuowwoom)Tapalm pliadOS(13400g reloptte I I Opuvp uropid T1 ,tlgrjo op a• ,
• • Lt!- Vf11 n 41 CI -3wIIV N-V6wVI-F
(Papcauwaoa9 opzijN vIppirAt PJvP" OWN Mfg , '• rpwlU 9traaN;ggrx
• aro>MOpoae &JoiBlafutquq,t)VMOIv9 <Veiaxi•astugx
.-. . - txaq •
WON—Y:4ALa 1 :990
NUR WOW- v< c91s
O
ovItc W. .410 VLrol. 99o9vi.( PI )
- - '6IEO$ UAlursoJgdfl tug ,
azaziso NU;1cat im r OW - aodaj54,4'SPIV
ox$go 5awa7D zzio ' rool�-jt1'nvsA iFiRoo "aedOIXoddns
.31W 4VA1)I RD A4.10 roto" 40d1b2!lra ti,SlbRtttlM.10mop:A;gaAtur :ox '
cis ' , _
• -.coo-6 ';aoquirmutt000yI3Cd .
:r, , ,
� 7b,1 rt. ,4,_• . ; ttuo&3Olg :n � 7*�fAii ,y �
�� vpn p .
fi
,' -tofu s,th, Y lll�oLJ,® ,�Y FIUAy I 4b .+j .I4"r'.' :+4Y f .
•
: , ', , r ,
. . ,
• ■.:
l/l 'dd S9S£1'oN� , uoi1P3ijsanui j'eu !tu! i'3 '10 ANO) IRKS :6 Eioi •Q A'f A
OrIowa Department of Transportation
J. Office of Driver Services (Toll Free)800-532-1121
PO Box 9204,Des Moines,IA 50308-9204 515-244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 10/2/2013 DL/ID It: 624AH0863 (IA) Customer#: 6009453
Name: Hamdan,Ahmed Class: D ID Status: None
Bukhary
Address: 2658 ROBERTS RD Audit It: 6240863 DL Status: VAL
UNIT 2C Issue Date: 08/23/2012 CDL Status: None
City/State: IOWA CITY, IA Expiration 01/01/2017 CDL Cert None
522462743 Date: Status:
Endorsements: 2 CDL Med None
Status:
Mailing Address: 2658 ROBERTS RD Restrictions: NONE Restriction None
UNIT 2C Date of Birth: 1/1/1969 Supplement:
Mailing City/State: IOWA CITY,IA Sex: M
522462743
History Information
CLEAR DRIVING RECORD
Name: Hamdan,Ahmed Bukhary DL/ID: 624AH0863
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:
44PIF j'h
t. .4+L 10/2/2013
I • IOWA":4.4s
odireldpre
tit D. O. T.le
h,'hv''''''e r Office of Driver Services
nfi1 xw Iowa Department of Transportation
Name: Hamdan,Ahmed Bukhary DL/ID: 624AI10863