Loading...
HomeMy WebLinkAbout13-188 r r Authorization Number ) I _ 1 (Office Use Only) III 'It Me Mg I 1141r 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 _ Cow._ /W DAt>. g/,3fe (319) 356-5497 FAX First 1 Middle Last 1. Name M o Ji a Y►'1 e Ol /4 acsc vi H U S S 1 IV 2. Mailing Address ,‘../t) Bart eIt` /?o apt I !1 3. Telephone: Home -3-o 6 4,0 91 3 3 Other: fob 46'/ 9/33 4. Prior- experiencef� in transportation of passengers: 4 1// /� /) 7 I [ L�J/ (} Taxi- W^W� !w 5-S�5 lL1'�1 j1c Iw T1i1evic, C� A, 308.0 ihou -30 ✓T9 922f- filo 22* f1- .ZOO r � - at O) 3 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? hV 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? /V6 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where p When pedit's F Erl' ev'a�$tvAl/c ,44P0 S ls, a 3- - 2.0'13 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? !V 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) derkltaxidrivbadg 03/2013 • I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 7:23 A ) Li-900 . 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) �(1 Signature of Applicant Date 061:- �g -.0)3 ************************************************************************************************************************************************ STATE OF IOWA COUNTY OF JOHNSON ) SOscribed and sworn to before me by ‘C\ kuss\r� . On this day of ys a�� \` J v Nota 'ublic in and for theState of Iowa ? i30L-t ************************************************************************************************************************************************ 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). (74// ' (F.-021"a Sig ture of '/.I. 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. k' /1.,4 � a - I3 SignatL4e 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 clerkRaxidrivbadgeapp2010.doc 03/2013 • Page 1 of 1 6- /' Iowa Department of Transportation �I , Office of Driver Services (Toll Free)800-532-1121 PO Box 9204,Des MII oines, IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 8/20/2013 DL/ID#: 723A)4900 (IA) Customer#: 6130802 Name: Hussin, Mohamed Class: D ID Status: None Hassan Address: 2610 BARTELT RD APT Audit#: 7235008 DL Status: VAL 1A Issue Date: 08/13/2013 CDL Status: None City/State: IOWA CITY, IA Expiration 04/24/2018 CDL Cert None 522462731 Date: Status: Endorsements: 2 CDL Med None Status: Mailing Address: 2610 BARTELT RD APT Restrictions: NONE Restriction None 1A Date of Birth: 4/24/1975 Supplement: Mailing City/State: IOWA CITY, IA Sex: . M 522462731 History Information CLEAR DRIVING RECORD Name: Hussin, Mohamed Hassan DL/ID: 723A]4900 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: ' Ep� o t• • po, y8/20/2013 ecriczta(VI)...... Office of Driver Services y It'l OBIYtF s= Iowa Department of Transportation Name: Hussin,Mohamed Hassan DL/ID: 723A34900 8/20/2013 % Aug. 27. 2013 3:24PM Div of Criminal Investigation No. 5309 P. 1, ■—V` nUS. LV. LVID 11 • JVnlll tilt] VICIn Vit] VI luno Vi IY ttu. JI IU• I. L/ 2 • • • ' /iY i STATE OHO A ` o f4.. :�• ,, • 't d brira>rtr�g$•gistorcy ,peso 'cl Cheek r.e.o s,dpve;i1' LI.: i �'�'!101ia.l� 1�, RequegtJF+or<m .ii,PpnIN o-,,, • riCxAaoountNumber: ii-DDa•---r-- , • QtnpilrMblo) • • T'o; lawn Division ofSerninaIllwasftgut(on Prom cm of iota OM • Support Operal(dns Durum,V IVO or an* =Zia oiEXaE a1S0,114Street • 4111 -R_ xJA3r OION sTR$3i bey)t?ptnos,Towa 50119 • (919)725.606€ Tows CTU TOM_ 52&o (SIsO 924-6090 Irani , l'honap 91q-156 5041 _ , • . }7921 $TB-•sc6—' q7 'Tau re t uestfn�anro\VA CrimfnoiRisco _ R000rd Cheok on; Last Mame tslldaloce) • FirstNnmo moray • middl&Nome oevmeleaAtd) • IMENIII i'"1 ©ha rn 2 d 14 ctss cwt Data o'Birth camel) denl1ex snots ) SodfaSeanti/NW ar(retan,mcars) Cff / .291 Iq �5 Ir a10 ' em'aYs• 19I oq one Vatifen fo7711aifa)7;Withouta.al a vvA'e1'fl'ontthosu)SfeetdittoxNQpe4P atosnpletacl•Irubbitiffsforymorel/uaylloC Ytsrersa.9nnrrypot'Cadoaglow,,Cha-pter692.2.JttoxeohtpTetoerinvhrafhtstoryreeordheCokroatfo:dlnsaliemedEyluwdfp p ' ahtaih(11 at freed!aaturaThom t)'(o.snb dotoY'9Tralre'Via; afrer1?eIgfs.r Thcrebygtyapelf/161 uforaroobovaxcgaarrmgoMgf!ta ONIIIONaroWil Ohba!l'6roryteoorddfeckwirhTablitnprGlminal • Y1valfgerraft0C1).An&k!ill(arydetAoeocm(ngntorhatlsma/ala(nedbytheb4Tmpybaratcareci0&AIMbyrgv • a ArrilYeltgignnlla'e 2 iowa CrhnThg1I il�Wox�'kee,o di CL.eek Iteani , ' @C)uaeg�y) �lgof i�� 1�3 ,asearhoz"fila,provftfed.name�uddatocd�ii.'tit•roveale(II ' inP • NoXowaCilminsd.T lstory lecordlfoundwithDCI C7 iom 0/kind 'lsipryRecordattaohed,.CII/' Received Time Aug. 20. 2013 11 :55AMx111o. 4324 le.--- •• I:" -