HomeMy WebLinkAbout13-212 Authorization Number 13 —
I - j (Office Use Only)
inerritayialia..61
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
First �� Middle q Last
1. Name � Vwv�`t L\ ELS t o�c� i C13. . v-•,
2. Mailing Address c3( CI(A-g JT , a'y-c-(Uyi t l g \A - ,;,)a
3. Telephone: Home 11— CI — 9" 9 c l Other:
4. Prior experience in transportation of passengers: e ( / C at) J'Y,l V aA
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or els:
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Type of offense Where ii ►-�o 3'
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6. Have you been convicte of op rating 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? (U
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 7j(
1(
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 rrVC\
tame(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)
•
clerMaxidrivbadg 0 3/2013
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
'-13 \/ / (P9)C'1 D . 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 recirds and documents relating to this application, and I further agree that, if a license
is granted, to comply at all times with all of he provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public)
Signature of Applicant Date SP 1 v 4-
ti 96 )3
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before. me by i t,_ .. C;, A. E , }-1 ma el, Lk;,,,_ . On this I ?)-Lt( day of
Us. os ►-eQ- _ 5 -_ate A�
Notary Public i and for the State(Iowa
111
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STT- ,1 .********************************************************************************************************
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).
//4 / . tea,
Sign-ture • o ice ' ief 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.
Signa re of City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width)and 5 '/z"
(height)and prominently displayed to all passengers.
************************************************************************************************************************************************
Office Use Only
Approved application
DCI report
State certified driving record
Website update
•
clerkkaxidrivbadgeapp2010.doc 03/2013
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Received Time Sep. 10. 2013 3:56PM No. 5574 '
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Iowa Department of Transportation
I f Office of Driver Services (Toll Free)800-517-1121
stile PO Box 9204,Des Moines,IA 50306-9204 515-244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 9/10/2013 DL/ID#: 713YY6890 (IA) Customer#: 2068875
Name: Hagelamin,Tawfig Ali Class: D ID Status: None
Elsiddig
Address: 811 HUGHES ST Audit#: 6119105 DL Status: VAL
Issue Date: 07/12/2012 CDL Status: None
City/State: CORALVILLE, IA Expiration 07/16/2017 CDL Cert None
522412143 Date: Status:
Endorsements: 3 CDL Med None
Status:
Mailing Address: 811 HUGHES ST Restrictions: NONE Restriction None
Date of Birth: 7/16/1980 Supplement:
Mailing City/State: CORALVILLE, IA Sex: M
522412143
History Information
CLEAR DRIVING RECORD
Name: Hagelamin,Tawfig All Elsiddig DL/ID: 713YY6890
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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II'�AO%"•••"'caw
lbyr Office of Driver Services
Iowa Department of Transportation
Name: Hagelamin,Tawfig All Elsiddig DL/ID: 713YY6890