HomeMy WebLinkAbout13-192 Authorization Number
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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 0 �t�1a Da
2. Mailing Address Z 6 3, W h j S ie fit) rvotAv142 fV e Iowa C :1 N A 57_, I4-�
3. Telephone: Home .3 i c{ _ i` 6� 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 State or elsewhere? /I/O
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? :e4
Type of offense Where When
Lam.
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8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /✓D
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)
clerk/taxidnvbadg 03/2013
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
'. ,9"G- 0,5-171 . 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 C/ Date 7l2 eC
(
STATE OF IOWA
COUNTY OF JOHNSON )
Subscribed and sworn to before me by ate( f'//uj -Sa f,. . On this -2`f day of
��try
'Not Public in and theS atIowa
************************************************************************************************************************************************
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).
Sig ature ofic1 e Chief 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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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 1/2"
(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
• Jul. 31. 2013; 12:49PM Div of Criminal Investigation • , No. 1100 2%P. . •
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Received Time Jul. 2.9. 2013 2: 08PMNo. 1121
Iowa Department of Transportation
pp Office or Omer Services (toll Free)800-532-1121
PO Box 9204, Des Manes, LA 50305-0204 515.244-9124
FAX:515.239.183?
Certified Abstract of Driving Record
Inquiry Date: 7/25/2013 DL/ID#: 545AG0871 (IA) Customer#: 5868786
Name: Sailh, Omer Elhaj Class: D ID Status: None
Address: 2630 WHISPERING Audit#: 5935755 DL Status: VAL
PRAIRIE AVE
Issue Date: 04/20/2012 CDL Status: None
City/State: IOWA CITY,IA Expiration Date: 10/15/2016 CDL Cert Status: None
522406812
Endorsements: 3 CDL Med Status: None
Mailing Address: 2630 WHISPERING Restrictions: NONE Restriction None
PRAIRIE AVE Supplement:
Date of Birth: 10/15/1967
Mailing IOWA CITY, IA Sex: M
City/State: 522406812
History Information
Convictions
Citation Date Conviction Date ACD Explanation County ]UR
03/03/2013 03/25/2013 592 Speed Johnson IA
Accidents - Accident involvement indicated does NOT mean the individual was at
fault or given a citation.
Accident Date Case Number ]UR
09/20/2011 648800 IA
Name: Sallh, Omer Elhaj DL/ID: 545AG0871
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:
Oita Ap;',�Lilo 7/25/2013
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Iowa Department of Transporation
Name:Salih, Omer Elhaj DL/ID: 545AG0871