HomeMy WebLinkAbout13-195 Authorization Number /3 - I 1
_ 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
(319) 356-5040_ Q {fit L /fel` "'?. "4"45,• d
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(319) 356-5497 FAX
MOIdl /� Last
1. Name A/ir;t1
" te. (G� ��/fie.% AL=
2. Mailing Address /?,-,( l,/( �JA,-f i•..12 A l i�,- ' r C 1:7 ` c
3. Telephone: Home Other: S 1 S - `( \c"\,-Sk of`�
4. Prior experiencerrin transportation of passengers:f
�C�G( 0-- (�C�i - a �u.rct�! �1 c<nv CLt�
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /p
Type of offense Where When
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? ,(7
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? /`(6
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)
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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 number
(cs. . I understand that if I falsely answer any questions in this application, that this
application m�y 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 tt Date]c/3 v( /.3
STATE OF IOWA
COUNTY OF JOHNSON )
Sukscribed and sworn to before me by rn oV\ ry\ 'Os �A.-\ `� . On this day of
\
NOary blic in and for ffie State f Iowa -713114
*,.*****.****************************************************************************************************************************************
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 ture of olicetChief 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.
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'/2"
(height)and prominently displayed to all passengers.
************************************************************************************************************************************************
Office Use Only
Approved application
DCI report
State certified driving record
Website update
clerWtaxidrivbadgeapp2010.doc 03/2013
lug. 29. 2013 2: 29PM (Div of Criminal Investigation. NNo. 4316 PP. L1/1
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El Iowa Criminal B1sfQYi Radon'attnohed,b OT# •
Received Time Aug. 23. 2013 2;21PM)'•No. 4923
. ,
iirlIowa Department of Transportation
tii Office of Dhver Services (Toll:Free)800-532-1121
PO Box 9204;Des Moines,IA 50306-9204 515-244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 8/23/2013 DL/ID #: 102880710 (IA) Customer#: 3602586
Name: All, Mohamed Awadalla Class: D ID Status: •None
Mohamed •
Address: 1301 MUSCATINE AVE Audit#: 4881946 DL Status: VAL
Issue Date: 12/14/2010 CDL Status: None
City/State: IOWA CITY, IA Expiration 12/15/2015 CDL Cell None
522403218 Date: Status:
Endorsements: 3 CDL Med None
Status:
Mailing Address: 1301 MUSCATINE AVE Restrictions: Corrective Lenses Restriction None
Date of Birth: 12/15/1968 Supplement:
Mailing City/State: IOWA CITY, IA Sex: M
522403218
History Information
Convictions
Citation Date Conviction Date ACD Explanation County ]UR
08/06/2009 09/02/2009 S92 Speed (10 mph&under in 35-55 m_ph zone) Polk ,IA
02/18/2012 03/20/2012 864 ,No Insurance CardJohnson 'IA
Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date Case Number JUR
01/21/2012 1669245 ;IA j
Name:All, Mohamed Awadalla Mohamed DL/ID: 102660710
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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23/2013
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Office of Driver Services
4h,Bs1YE _ Iowa Department of Transportation