HomeMy WebLinkAbout13-182 Authorization Number /3 / g a'
1 (Office Use Only)
VIII vs
aftisougy
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 52240-126
-3-r9T.356-5-0:40. Fri Z 3
(319) 356-5497 FAX
FirstMiddle Last
1. Name W/\LC L h l/ b
2. Mailing Address 26►j 2 to(3 P V1 2 -
3. Telephone: Home Other: 7 7 - 6 6- c l 9
4. Prior experience in transportation of passengers:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
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
V L�
7. Have you been convicted of any traffic offenses in the last five years?
Type ofoffenseoffense Where When
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 an Iowa City taxi driver using a different name? If yes, please provide the name(s)
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 i sued to me by the Iowa Department of Transportation a valid Chauffeur's license number
t1 A 2,A)(c"A . 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)
7/ �,iVim ' � ?
Signature of Applicant Date C� /2 3/Z0 3
.******************************************************************..*,.**************************.***********************.*********************,..
STATE OF IOWA )
COUNTY OF JOHNSON )
�ubscribed and sworn to before me by `-`•\�-- -&. , \ck wc.�% c�. . On this . 3 r kday of
V3_,sk a o1__ . _ •
�tiotar�Pu Alio in and for the State of Iowa
'71311`4
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).
4111.7.44--\_______ �'� 13
Signatur of Polk/' ief 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.
Signartur�of�City Clbrk or designee Date
Taxi cab businesses are quired to provide Driver Identification cards. Cards must be 8 1/2" (width) and 5 '/z"
(height)and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
clerkttaxidrivbadgeapp2010 doc 03/2013
•
Page 1 oI 1
21
fIillIowa
Department of Transportation
Office of Driver Services {Toil Free)515-542-1121
PO Box 9204,Des Moines,IA 5®3FD5 9244 tigiliP FAX:515-2394837
Certified Abstract of Driving Record
Inquiry Date: Hamad,
a2013 DL/ID #: 497AG2888 (IA) Customer#: 5795271
Name: HamWaleed Mohd Class: D ID Status: None
Hamid
DL Status: VAL
t#: 5239392
2C
Address: 2652 ROBERTS RD APT udI sue Date: 05/20/2011 CDL Status: None
City/State: IOWA CITY, IA Expiration 10/29/2016 CDL cert None
522462740 Date:
Endorsements: 3 CDL Med None
Status:
Mailing Address: 2652 ROBERTS RD APT Restrictions: Corrective Lenses Supplement:Restriction None
2C Date of Birth: 10/29/1979
Mailing City/State: IOWA CITY,IA Sex: M
522462740
History Information
Convictions ,
County JUR
Citation Date Conviction Date ACD Explanation - ,Johnson IA
01/27/2012 }03/30/2012 _E55 `Driving Without Headlamps or With Park Lamps
_.. .. ;Speed
03/19/2013 ,05/31/2013 592 ;;Speed (10 mph &under In 35-55 mph zone) 'Johnson IA
Name: Hamad, Waleed Mohd Hamid DL/ID:497AG2888
Pursuant to Iowa Code §321.10,I, Klm 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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CF4FOPoYERs"r owaeDepartment of Driver eoflTransportation
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Name: Hamad,Waleed Mohd Hamid DL/ID:497AG2888
8/16/2013
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