Loading...
HomeMy WebLinkAbout13-214 Authorization Number /y ' t/ T - j (Office Use Only) mo .. .EEG gr aXlll, �' ®���1 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 1. Name First „fOc4 420? Middle „o 40 /liP / Last "a m Q o,( 2. Mailing Address 26 y- Ro4ekvt S fY d /ft ?_� �c Iii C /l II) cZ Z 7 (� 3. Telephone: Home 3J9 59 9- .?/ 8 Other: C1� �MP r ,X J /I , 4. Prior experience in transportation of passengers: S >tn ,j r� 1A/ /4 C' I+ �. `' ) 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or els: r. 1 Type of offense Where x""'03 I E • 6. Have you ben onvicted 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? re< Type of offense Where When / j-A 0 2/2/20o /4.34,5/2d 1111/ 11"0Pe Pe -5 I sf watl.9'o/t I /1 )2104^ � d 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 1� Ul U 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) AID 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 riumbe?% !./ P 45" . 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 ` tS Date c Oil26'� STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by eiczki,itri tak_ . On this Lc{ Lz day of ra iA.9.JAA1. at1l S Notary Public in d for the State of loch AMID'a mar. lade At*eriNifty**** *** * *4 *tor** ******************************************************************************************************** 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). Sign re of Pol e/ hiercresignee 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. 7/1f2/4',40.-yz/ ��} `r/'q/13 Si nof CityClerk or desi nee g g 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 clerldtaxidrivbadgeapp2010.doc 03/2013 Sep, 16. 2013 2: 04PM Div of Criminal Investigation No. 6222 P. 1/1 I D V• 1/I u.' C 1) V 1 4 I n V I \! V I I O 4 v I \/ NL. a P. I/ I ep1 14. 2013 i:i1 Ulv oT Criminal InvestVigationr INo. l�II Ir. 0/6 f•.1 ry I•.. cv 1 v •) v .4 v v. 1VOw VI \ 1 , . , 1 . , t .- . \. • I ' • ) • , I N 1 // Sir. /�V'i .ql\ y{�y!//l��yyJ.•YI/II/�I�Wpl` 4 H: • ,' It1'Jliti \t. Y • '!�/1`�N'�NJ \LY-0T IYYYYv+'. 7YKTI}}•4��1�fi ; / 7nYln y� z x ••c, J '�t �}"/'� /� �Jl7�YulurA��y�� �f`OS�y�560YL1� Check ��a(�s}�'nr•�; . fr( .} , \brr , .qv,©�tHP.g�ll+`Ox➢HE -Yip,`,'`:n�S" i / / /e,raril;. • • 1 D t5000tIntlilimberl e• fob�` . ' • \ " 1 • Fll,l o ' To Xo1YAAMA 6tComtnnl.th'vadt4hl(6h GYoml ata: w$Inn 0YIC • su portOorst(orellttektir,til]1ffipe J m1.rT�CTV deVAV a,X6A17�Sl of / 1 z, r.plur. rat's i/ bakl�p/gev, lowa SIVE • - (Si bar Srnri 3OWA. CIS TO 52?l0 1111111111 1 Honer 19/°556 5041 )+'4kl319—;c,614gY , Ya 1re,noir(':amfolvteAn6m YM' o,, •ecord Cheek on; 1 Lost auto(wilt/0) • J71 ;t allta(mPniUery \ is,dal5Nptze(eetoorea ert. ' MMAD /11, Vedadt- /1404 a tie Ol itioo>:'l'ji't`i{0ndarlly) GIeha'ox'I ox(•to\ SIdetdrSlooltl' 1 TQi1M')ot\ cmrnnnnOa • Op /�/O , ►_ ♦ do" TremaYb k► 1 effor )'J YJ I/oI/; !WIo1(ta.aigthAVglvatarontibavult(totnetgGYerp1Aa4 a miffed o?Th6i T6(efo rceor�'nm)/noa .66ko1e0lhb14wayCuit o$Y4Wp,ChagtorWailroroh brfnildn(hifila. /:'eaol'dlolbtmnifert,a!s(�q� 1� A(Ngy9 obtafte atVoiesl, (ltd .1 1 oer(b dodMiro k• Al fo' 7 fa I •11 ♦ ' �jafrav Areapithesnfrooem1Q(a116)TD(o1DorenrtlagoMaler(oror(illileahNotmnATbMroWie4 4P-aoVLThI e•' t•r1 • 'G' / 17YNt/beIfoAQodq,Mya/mf6dnlrrotHead4nIVtufral 4Nd&m!fnufaadl�glfobefmlybor4(ft fl (\Y4 yram1 His . a' , , . S ' �M ia� o- I F i , ik '' • :aI COrfh;l 1. 3t'e ' • gine,/ acre, .' a� r'f9 ' � , - • (oCTwncrRy) Au of (Id urt5 ,aaearthob°t1la$evfficdetatna vudcUntc o!Sathd'Vdaled: ' N' liKrizaina}idgistotyitotoYdQdl1,1 /wit Da • • . , . . Received TimelSep.16.'C2013'aY9Yi18AMt;`r. o:7652°hey, C ' A I TI . A In AAIh IA rant? L rrnn 4 Iowa Department of Transportation J. Office of Driver Services (Toll Free)800-532-1121 PO Box 9204,Des Manes,IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 9/10/2013 DL/ID #: 241AD4645 (IA) Customer#: 5400638 Name: Hamad, Mogahed Class: D ID Status: None Mohamed Alhassa Address: 2654 ROBERTS RD APT Audit#: 7202303 DL Status: VAL 28 Issue Date: 08/02/2013 CDL Status: None City/State: IOWA CITY,IA Expiration 08/02/2018 CDL Cert None 522462741 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 2654 ROBERTS RD APT Restrictions: NONE Restriction None 28 Date of Birth: 8/2/1980 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522462741 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 02/03/2009 :02/23/2009 592 Speed (10 mph&under in 35-55 mph zone) Linn -1A 10/21/2011 12/04/2011 jImproper Registration Linn ,IA 01/29/2013 '.03/05/2013 1592 'Speed Johnson (IA Name: Hamad, Mogahed Mohamed Alhassa DL/ID: 241AD4645 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: AE®ICIE ias .1.. .. ti...................., 9/10/2013 sem: IOWA . % 3=:D. O. T. % ceeine szeotoz4 „fr.. _ Office of Driver Services hx�wz,,YE®.�-' Iowa Department of Transportation Name: Hamad, Mogahed Mohamed Alhassa DL/ID: 241AD4645