HomeMy WebLinkAbout13-184 Authorization Number i - � ?Lf
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,61
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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
(31 9) 356-5040 Cp-L-t AA Gus c7'
(319) 356-5497 FAX
First Middle Last
1. Name k/IA6i7 A FLMA6r-F\ M0EtAMi✓p AL
2. Mailing Address "! // c{,,,---\ e
3. Telephone: Home yi f (-.:7 I ( 5 Other:
4. Prior experience in transportation of passengers: `f�� � 7 a
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
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Type of offense 1(1/here When
6. Have you bean 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? ` :
Type of offense Where When
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8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
Type of offense Where When /
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9.
. Have you ever applied to be n Iowa City taxi driver u in 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)
Gerk/taxidrivbadg 03/2013
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number N
L/o. 3. A \- 9 ; . I understand that if I falsely answer any questions in this application, that this
application may be denie 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) I /� -
Signature of Applicant �' .� Date , I
O TS
C fir
STATE OF IOWA )
COUNTY OF JOHNSON )
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Subscribed and sworn to before me by Al ct, . 41 . On this a 3 day of
;� s� SONDRAE FORT
�'' Comrnission Number 159791
sMy Commission Expires Notary Public in and for the State of Iowa
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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).
�4/4►/ G2?-/.f
Sign/,
ign ure of P. c. 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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S . : of City Ark or designee Date
Taxi cab businesses are regtred to provide Driver Identification cards. Cards must be 8 '/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
c erk axidrivbadgeapp2010.doc 03/2013
' . A o. 16. 20133' 4:40PM, . , ;Div of Criminal Invest igation Y:.';:- • . No. 40131 • :8, 8/8 '
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Received lime Aug 13. . 20.13 3:01PM No.)43 ) " ' '
,
rilli) Iowa Department of Transportation
�s Office of Driver Services (Toll Free)800-532-1121
PO Box 9204,Des Maines,IA 50305-9204 515-244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 8/22/2013 DL/ID it: 463AF2313 (IA) Customer it: 5747667
Name: All,Magdi Abdelmageed Class: D ID Status: None
Mohamed
Address: 2411 BARTELT RD APT Audit#: 6351071 DL Status: VAL
2D Issue Date: 10/02/2012 CDL Status: None
City/State: IOWA CITY, IA Expiration 01/01/2015 CDL Cert None
522462706 Date: Status:
Endorsements: 3 CDL Med None
Status:
Mailing Address: 2411 BARTELT RD APT Restrictions: NONE Restriction None
2DDate of Birth: 1/1/1980 Supplement:
Mailing City/State: IOWA CITY,IA Sex: M
522462706
History Information
Convictions
i
Citation Date Conviction Date ACD Explanation County RIR07/14/2012 '08/16/2012 1592 ,Speed Johnson IA
Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident DateCase Number JUR
12/18/2012 _ - 1717412 IA
Name:All, Magdi Abdelmageed Mohamed DL/ID:463AF2313
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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