HomeMy WebLinkAbout13-206 0111 Authorization Number I — a h i 9
— 1 (Office Use Only)
9466.
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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
(319) 356-5040
(319) 356-5497 FAX
First Middle -Last
1. Name V/V/O MIIrttR rE) �c� EL S5/�� ✓
2. Mailing Address 24 G"( (4- +ed # ZL 1 - C(1,5-76 22-76 5
3. Telephone: Home 70 1499 119 _ Other: 3 f 9 It 69 o 2
4. Prior experience in transportation of passengers:
3 e-((
imam isior•ENA-1
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or el -�/1111117V
Type of offense Where When
6. Have you peen 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? (J 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? A)
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)
derlataxidnvbadg 03/2013
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
(-1-1,13.7( ?( 9 .5 — . 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 // 2/�g
************************************************************************************************************************.********************
STATE OF IOWA
COUNTY OF JOHNSON ) - '1 .S
Subscribed and sworn to before me by .j)„i„„_,&& LA. ,. ' � y1Jla(q rQ . On this U,/\_ day of
comms sw�*NW Mae
'!
-
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�c��1�lnMw o_ary Public and for the State of I a
************************************************************************************************************************************************
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).
Signa e of Pol '- hief 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.
- C1//cjj
ignature 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
derkttaxidrivbadgeapp2070 doc 03/2013
rp. 10. 2013 •11 : 31AM CDiv of Criminal !Investigation do. 5466 PP. � 1/8
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Received Time Sep. 5. 2013 12:3n3PMyNo^6240 go .
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1111N Iowa Department of Transportation
c83 Office of Driver Services (Toll Free)800-532-1121
PO Box 9204,Des Moines,IA 50306-9204 515-244-9124
FAX 515-238 1837
Certified Abstract of Driving Record
Inquiry Date: 9/12/2013 DL/ID#: 428XX5832 (IA) Customer#: 222610
Name: Abo Elhassan, Muna Class: D ID Status: None
Magribi Mand
Address: 2608 BARTELT RD Audit#: 4752474 DL Status: VAL
APT 2C
Issue Date: 10/15/2010 CDL Status: None
City/State: IOWA CITY, IA Expiration Date: 01/01/2014 CDL Cert Status: None
522462730
Endorsements: 3 CDL Med Status: None
Mailing Address: 2608 BARTELT RD Restrictions: NONE Restriction None
APT 2C Supplement:
Date of Birth: 1/1/1974
Mailing IOWA CITY,IA Sex: F
City/State: 522462730
History Information
CLEAR DRIVING RECORD
Name:Abo Elhassan, Muna Magribi Mand DL/ID:428XX5832
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:
9/12/2013
t..1owA
:•D• O. T.
.• .. : Cylgempdr Eslagsrgos4.
Office of Driver Services
Iowa Department of Transporation
Name: Abo Elhassan, Muna Magribi Mand DL/ID:428XX5832