HomeMy WebLinkAbout13-244 Authorization Number rj `( Li
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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
1. Name J c--4/14-T-6Micelle Last /E _!/!/i
2. Mailing Address / &/ ng[- A/L.= ca Lte-7 de.;
3. Telephone: Home 9-41 7/- T � 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:'S'''�:,;'.A al
Type of offense Where
When
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6. Have you bQen 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
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8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 1,qq/ 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)
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)
c er ataxidrivbadg 03/2013
I h17771
rec i tat vg issued to me by the Iowa Department of Transportation a valid Chauffeur's license�nutinbee ,
6 / . I understand that if I falsely answer any questions in this application, that this
application may be enied. 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 r Date/d/ ///J
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by u.t e' G s1 G-IAA c4, . On this TL,t L day of
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WENDY S.MAYER
2 �Art� Iowa GVf1111IfiD.V.Nuvnbc 729428
41...
• My Commission Expires
i —1?,-11 Notary Public in nd for the StatCot Io
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).
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Sig ature cerolice 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.
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Signature of City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width) and 51/2"
(height)and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
clerk!axidrivbadgeapp201 o.doc 03/2013
Sep. , 5. 2013 4: 22PM Div of Criminal Investigation No. 6333 P. 2
, Aur. 29. 2013 3:08YM City Clerk — City of Iowa City No. 3024 P. 2
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Received Time Aug. 29, 2013 3:08PM No. 5599/,i
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Iowa Department of Transportation
if: Office of Driver Services (Toll Free)800-532-1121
PC)Box 9204,Des Moines,IA 50305-9204 515-244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 10/8/2013 DL/ID B: 131AC5876(IA) Customer tt: 5239074
Name: Slama,Kamel Gassmelseed Class: D ID Status: EXP
Address: 1454 ABER AVE Audit tt: 6916748 DL Status: VAL
Issue Date: 05/03/2013 CDL Status: None
City/State: IOWA CITY,IA 522464700 Expiration Date: 08/02/2017 CDL Cert Status: None
Endorsements: 3 CDL Med Status: None
Mailing Address: 1454 ABER AVE Restrictions: NONE Restriction None
Date of Birth: 8/2/1966 Supplement:
Mailing City/State: IOWA CITY,IA 522464700 Sex: M
History Information
Convictions
Citation Data Conviction Date ACD Explanation County JUR
03/15/2009 '05/12/2009 592 Speed(10 mph&under In 35-55 mph zone) !Johnson IA
07/05/2011 08/22/2011 _ S92 _ iSpeed _ _ _ _ _ _ _ Jahnsan IA
09/11/2012 10/21/2012 592 .Speed Keokuk ,IA _7
08/06/2013 08/23/2013 592 Speed(10 mph @.under in 35-55 mph zone) Keokuk !IA I
Name:Slama,Kernel Gassmelseed DL/ID:131AC5876
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:
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rlly �AIS owaaof Driver Departme Department Services
Name:Slama,Kamel Gassmeiseed DL/ID:131AC5876