HomeMy WebLinkAbout13-191 Authorization Number i 3 — ( I
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CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER
(Police Department review must be made
410 East Washington Street between 8 a.m.to 3 p.m., Monday-Friday.)
IowaCi Iowa 52240-1826
(319 356-5040
(319) 356-5497 FAX
First /� Middle _ Last
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1. Name . .(-3E,_/ iTGA R 1( HA LLL .SEE i-I/1 ED
2. Mailing Address 2‘.6-"e" n. erts kr)acl APT t' 4owa c'� IA 62246
3. Telephone: Home Other: 4)6 2 02_2 O 2l
4. Prior experience in transportation of passengers: / I/ Ylz LAS a /El l i n i r'64.6 1 yeas
vies-- Lvr, �f� ii 37 e&/Ys
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? NO
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?
Type of Offense Where When
/41
7. Have you been convicted of any traffic offenses in the last five years? /VCS
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? AJ(.'-)
Type of offense Where When
9. Have you ever applied to be an Iowa PLD 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)
derlcPaxidnvbadg 03/2013
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license numbe'
6 § ( S `c\ . I understand that if I falsely answer any questions in this application, that this
applicat1'n (,�ay 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 -.� Dater. r 2 _U/ 3
STATE OF IOWA )
COUNTY OF JOHNSON )
Su scribed and sworn tc� before me by 20e-/7' CLr $eec JI/17/("_0‘._.. On this 2041- day of
t..-C.3 I i �.i•:/ 2 J/ _,—�
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IA<4KELLIE K.TUTTLE ie�C (r 1. /LL (-C
;.9 .
. Commission Number 221819
My cosor� �cayres Notary Public in and for the State of Iowa
C�
************************************************************************************************************************************************
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).
�e2�—� 3
gna ur of Police 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.
/ Jr. <_8'— /.-
ign. - 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 /"
(height)and prominently displayed to all passengers.
*************************************************************************************************************************i**********************
Office Use Only
Approved application
DCI report
State certified driving record
Website update
clerkkaxidrivbadgeapp2010doc 03/2013
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11
Iowa Department of Transportation
Office of Driver Services (Toll Free)800-532-1121 83
PO Box 9204,Des Moines, IA 50306-9204 515-244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 8/28/2013 DL/ID#: 684A37191 (IA) Customer#: 6082387
Name: Seedahmed, Zoelflgar Khalil Class: D ID Status: None
Address: 2656 ROBERTS RD APT 10 Audit#: 7286386 DL Status: VAL
Issue Date: 08/28/2013 CDL Status: None
City/State: IOWA CITY,IA 522462742 Expiration Date: 01/22/2018 CDL Cert Status: None
Endorsements: 2 CDL Med Status: None
Mailing Address: 2656 ROBERTS RD APT 1C Restrictions: NONE Restriction None
Date of Birth: 1/22/1968 Supplement:
Mailing City/State: IOWA CITY,IA 522462742 Sex: M
History Information
CLEAR DRIVING RECORD
Name:Seedahmed, Zoelflgar Khalil DL/ID: 684A]7191
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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jz:••. /,p p 8/28/20135*i :fro 9,,ree;7
ø44f•....• t Officewa of DriverServices
Sernt viicesnsportatlon
Name:Seedahmed, Zoelflgar Khalil DL/ID: 684A37191
Aug. 27. 2013 4:21PM Div of Criminal Investigation No. 5359 P. 1/1
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Received Time Aug. 19, 2013 4:3.1 n 3PM.No. 304t�_„ •
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