HomeMy WebLinkAbout13-213 • Authorization Number 13 - 1
I - 1 (Office Use Only)
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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
OFri 1113
(319) 356-5497 FAX
First Middle Last
1. Name r f1 L►1 ca 3 ct ►� M o y
2. Mailing Address Z O q cay-�e If K.61 -V:4 e :O y ; / b7 qt).
3. Telephone: Home (71 2c - Vie, Other:
4. Prior experience in transportation of passengers:
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5. Have you ever been convicted of any misdemeanors and/or felonies in this Stat 61140110101�
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Type of offense Where n
6. Have you be n convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? rJ
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? Nv
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)
N ---- --
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)
clerkrtaxidrivbadg 03/2013
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
1k ucti,51 . I understand that if I falsely answer any questions in this application, that this
application maybe 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 o q —
STATE OF IOWA
COUNTY OF JOHNSON ) At .1/4.)49cur
Subscribed a d sworn to before me by AhtQu` N-yIrak_A ou(' . On this /I day of
otary Public i 46:nd for the State of lo
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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).
Signat e of Poli f+Cfref 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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Sign:tiire 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 '/2"
(height)and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
Gerk/taxidrivbadgeapp2010.doc 03/2013
gip. 11. L2013 1 :e50PM CDiv of Criminal �Invest igation • NNo.5684 PP. e5/ 10
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Received Time Sep. 6. 2013 3: 23PM No. 5076,ca ,
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Iowa Department of Transportation
dr Office c*Dover' &wises (Toil Free)8Ob532.1121
PO Box 5204,Des Milnes,IA 503045254 515-2449124
NiueFAX 515.2304837
Certified Abstract of Driving Record
Inquiry Date: 9/6/2013 DL/ID#: 564AG6851 (IA) Customer#: 5901308
Name: Alnaggar Class: D ID Status: None
Abdulra/lman
Alnagar
Address: 2509 BARTELT RD Audit#: 7313168 DL Status: VAL
APT 113
Issue Date: 09/05/2013 CDL Status: None
City/State: IOWA CITY, IA Expiration Date: 07/03/2016 CDL Cert Status: None
522462715
Endorsements: 3 CDL Med Status: None
Mailing Address: 2509 BARTELT RD Restrictions: Corrective Lenses Restriction None
APT 1B Supplement:
Date of Birth: 7/3/1986
Mailing IOWA CITY, IA Sex: M
City/State: 522462715
History Information
Accidents - Accident involvement indicated does NOT mean the individual was at
fault or given a citation.
Accident Date Case Number JUR
05/05/2013 738563 IA
Name:Alnagar,Abdulrahman Alnagar DL/ID: 564AG6851
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:
X k 9/6/2013
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84'Ellia. Office of Driver Services
Iowa Department of Transporation
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Name:Alnagar, Abdulrahman Alnagar DL/ID: 564AG6851