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HomeMy WebLinkAbout13-216 Authorization Number — ..Q !3 l L � — 1 (Office Use Only) impoznaltr 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 GALL SLP. (o (319) 356-5497 FAX First Middle Last 1. Name ib IELLPF 2. Mailing Address 6G I Wc.ST'sv c A CITY (,gt r'3,?�b 3. Telephone: Home °7 03 4-3( 7 r e57 Other: 3 I g L5.7 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or - '- . Type of offense Where 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Arc) Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Af Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 717c-) 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) Af© 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) clerkltaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 5(4-I. A C 5b t p.7 . 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 Date 6ct do- STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by = 5 A1d jeIdci c. . On this V'CO"tL. day of •_� i M>K� ANAM Notary Public in 1 d for the State o boos ****** ********************************************************************************************************************************** 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). 771- �.I 7-a0-13 Sig ture of '.li, 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. 1)3 Signature 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 5 1/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update clerWtaxidrivbadgeapp20l o.doc 03/2013 fSep. 7. ,2013 . 4:48PM 1Div of CriminalInvestigationNNo. 5130 pl. , 1/3 • • ;a !lgir.. �} . fah 4 ) 1 t' ca' , Y J1�Th (OF h , �� na ���rl"�( blrinainattaistokyRecordJCheck I :�;, , pit •2'• , Jaequest Farm •�,.,„ ,R,• , • • - . DCIAce nntNumborf -E10A"F , (1t ogreibto) • • Tor XmvatPo(eionorCOMA alTvostket(4ti b'tomf cm or T t C1!W • Rapport alienator's rotreAV,Vino or - ( in cLEBK'G okk[c 215L`thRtteet • 411) 1L VslE7Nr7J�rShmiU bnSl*Inas,tom.60319 ' 6913)?Rag TM am TG9A 527ko (616)1a54a0 box . .phano, 919-.355^5041 • itaxt wrri—x56—VA7 lAmre�qqu�estingan.LoW&CI'&n(nail iston' ecordCheek an: a tigEthiq k40(nl iMt' FYrstNaitus maato)) 1 iddYo Name(facomga&dJ - IMIS I DfQ is R . ' Ditto o$T•1111t eaderofy) . . 0611.rex(mendifey) .YdM9iSOPll2'14VN1rinbor(rcaomrowde4 . a 3 — 9.4--- 19 56 - dale. ' Cf,rade 0216 6 a a 56 4- ' ,#Venin onird(iouj;Withoutaalgnea Wetrorkom Mssurtfectottho repeat;a eoinpleto cPFnbiAAdatory rteoxdMwynot 1jaxeleaJnkle1per Cada ot'Xnylal Ch aattorb92,2!AI(rotnpto(acrhu(efnlhtetoty reoordhrtbkinnt(an,asallowed$yPoi Afar °Masa • dyer sLnature fromtka.aubJoota(tner49tlbst: , • Wt VerRebbILrerakibygyeperditien tbohaa6ararique,ofagg1'cteifa lmtdeonothey°°aloha!hatelyeGoofdf(IeAwana9am2roneroammo( Yrirm7ni oh(POO.AW ur(andhIttotorata Mndum(ognlolbat7aniatnfatnedl i lonar7eybardeerod pd(owed byre: A'alvu SYgrta e; � i Iowa. Criminal 1119torrileoo,ilei Choo1 4gu'f1 . • tnomouib) A.s of3-- (i' (3 ,a se0toic o hoprovitfdd natio and Ata of b$.tb atvesYed; • NO IbW4 Gsluitudilistoty. ltecoxd>'bucawithDer ; 0 Yow4 t56n9naImatoryRooth casaba;DCY# Received Time Aug. 30. 2013 10i10AM No. 5678 )� ;•, 1 t•.nrl.rale_ fllowa Department of Transportation Office of Driver Services (Toll Free)800-532-1121 PO Box 9204,Des Muffles,IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 8/30/2013 DL/ID#: 547AG5067(IA) Customer#: 5872807 Name: Idris, Idris Abdellatif Class: B ID Status: None Address: 601 WESTWINDS DR Audit#: 5714153 DL Status: VAL Issue Date: 12/30/2011 CDL Status: VAL City/State: IOWA CITY, IA 522462755 Expiration Date: 03/24/2016 CDL Cert Status: Non-Excepted Interstate Endorsements: PS CDL Med Status: Certified Mailing Address: 601 WESTWINDS DR Restrictions: Corrective Lenses Restriction None Date of Birth: 3/24/1956 Supplement: Mailing City/State: IOWA CITY,IA 522462755 Sex: M CDL Medical Examiner's Certificate Certificate Specifics Explanations _ Medical Examiner First Name Torn Medical Examiner Last Name_ )Dean_ __ _ Medical Examiner License Number ,698 Medical Examiner Jurisdiction _ _ _ _ -IA _ _ Medical Examiner Phone ,(319) 339-3921 Medical Certificate Restriction 1 Wearing corrective corrective lenses Medical Certificate Issued Date ,12/05/2012 Medical Certificate Expiration Date _ _ 1t12/05/2013 _ _ , Date Added to CDLIS Driving Record - j08/16/2013 History Information CLEAR DRIVING RECORD Name: Idris, Idris Abdellatif DL/ID: 547AG5067 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: .eili .p.... . 8/30/20134*Iz:: : ^' s rrrOf�rlr...-a owaeDepartment of Driver eofiTransportation fiflNEd Name: Idris, Idris Abdellatif DL/ID: 547AG5067