HomeMy WebLinkAbout13-181 • Authorization Number k
� r 1 (Office Use Only)
� III�®a1�
itt1
ft., mosso
CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER
(Police Department review must be made
4 1 0 East Washington Street between 8 a.m.to 3 p.m., Monday—Friday.)
Iowa City, Iowa 52240-1826
wTt�'_'_3_3_"g s O'T0'T j7'r
(319) 356-5497 FAX
First Middle Last
1. Name A i\4-‘0,r ' rnv.SVc4z., fc\StA
2. Mailing Address )_ rjc 4 Bo$ kc, Ay\ #- I A \G AJ C fiy ) t O J a c a a.Li b
3. Telephone: Home '3 {9 U oc. G3 7 y Other: /
4. Prior experience in transportation of passengers: e‘J Pxe,i C� �`..,,.,t: C , C�)
C4(3 �
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Nj
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? NCS
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? N 0
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? r(\ i t 1
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)
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)
clerkftaxidrivbadg 03/2013
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
,.j`fq)\&- 77 t) ' . I understand that if I falsely answer any questions in this application, that this
plc tion 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) n
Signature of Applicant Aw e' Date %/.,Z/ 2_01 3
''„.� /a 3 l 201 3
STATE OF IOWA
COUNTY OF JOHNSON )
u scribed and sworn to fore me by /�MQ r El r—cz__ eCI . On this 2.3 rc day of
KELLIE K.TUTTLE �L` K
° i Commission um er 221819 Notary Public in and for the State of Iowa
•, r I41 GL EMPKoi
dddI0 `J{{
zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzt,t****z,t*zz*zzzz<,t,t�*t*,t,t*f,rzt*r�,tzz,tzzz,t*zzzzz*zzzzxzzz*zzzzzz*z*zzzzzzzzzzzzzzzzz,t**zzz*,kzzz*�z�*zzxzz**z: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).
Signat e of Poll- hief 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.
igon re of CityC erk or designee Da e
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/z" (width)and 5'/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
-Jul, 31. 2013 11 : 59AM ODity of Criminal Invlestilgation . . No. 1080.' PP. J13/16 . ,
•4 • L V• L V 1 J L I I"• I
( • . I 1 • •
r I 1 • •
•
I r - ' , • 1 1 ' t ,
' , • r ( '1 I ' ' • • ' ' 1
. f • . •. I •
}V . 1 S,TAIJT•E OF KOW�. =, n' .1�t `"3S. •.•, •
�(1 ) , ��y•LE• G
1$ 070' f .CW3'f 62201• Story Record. Ch eelk x�m 2,+` ��YYvU J;,
'
try
/•ihDE`J10. i� • 1 ' , J14equzit Form , c�,,r y`�. ,
•
• 1a =F
• . . Qtappliceelo) . . . . -
To; Sown))Ivlstonofer,5mra1]hwsii&aeloti -. j SYotn( OTTI 03 IOWA cza.7 ' •
Supp ort OtioraflnDa>3gwa,VINToor MT CZ1;Itt/0 OEPXag
213F11'h6YYoot • 410 R_ TTASB� (ud_STRii•F.T
bag*nth eats
01g7244066 Towel CITY MITA ' 52240
($13)128-6080 Het: • ,
STtand; 319-356-51141 •
ramrag aostiduaaIowa Criminal.ET1stor ?onotdCflookob; • ,
, Last l'0rm�manaaroyp • �S atMatooamoaefe,y) • Maas&rag((atameolthdi
ELa�r0.sk i AmcW Elmpista4rA
•
pato o f.1Bizlth Lwldrrory G60011 maithiol ) ' >Seatal SooturrtvNlmbor [toaromcpde3)
03/a6/196 y NiiVLare . ' nViarnaJ•e 6 9,2,.` f(-F— 3 el°9
.___ Wa4'eftInfarraaiov(;Withoutasi4nedwa1iverfromthesubjecteftbayognesi;atoola0Dli linalht?Foryrecordpnlyaoc
ilaralaatii;k3perCodeotXo'M,C9,apter69az.7sorcolnplotg•orintnalhistoryrocoidhdotrn oh,a.iaiiiivodhrtoilt(ways
• obtain I watvorsfangturehonit&o•nbjoetaftk,rogflest
T#?IferReIaa yeaherayglve perm fsriogTrlhoaenvaxagaasltagonivlAM to rondaor an l'o\vnorfnennf b4forytrAordolmeM\prY6 ThGDlfslon erenu raof
YnYesugatton(bOO,.µnyorlNMaf'Irony dnthe,npcm(ngnta,hat&ma/nlelnedEsgh6D4lmay ha ufcasM ov Nome,bylaw.
r
iveN5g�trlue; / 7Cr� tFA
• Iovvf Criminal}Tinton.fl60,brc?i CheckRest:Ytg . (oClwoal(Y)
Al of `7—_5 I— /3 ,ascatthop ita•providedname and des ofTsnaJzaovcarod: '
XNoTvwdC411i1fnaIli;9atotyAccord aural with DCX . ..,
U, Iowa athninal:H•1sto yRecordatte.ohed,DCIA .
•
Received time Jul. 26, 2013 2:40r1K4hN'o, 7T"` •
•1567-
I ,►'� Iowa Department of Transportation
ce Omer cervices (Tdi Free)�U 532-1121
1‘
PO Box 9204,Des Maines,IA 503D5-9204 515-244-9124
FAX 515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 7/26/2013 DL/ID#: 549AG7752 (IA) Customer#: 5876365
Name: Elgorashl,Amar Class: D ID Status: None
Elmustafa
Address: 2504 BARTELT RD APT Audit#: 6719060 DL Status: VAL
1A Issue Date: 02/22/2013 CDL Status: None
City/State: IOWA CITY,IA Expiration 03/26/2016 CDL Cert None
522462714 Date: Status:
Endorsements: 3 CDL Med None
Status:
Mailing Address: 2504 BARTELT RD APT Restrictions: Corrective Lenses Restriction None
IA Date of Birth: 3/26/1984 Supplement:
Mailing City/State: IOWA CITY, IA Sex: M
522462714
History Information
CLEAR DRIVING RECORD
Name: Elgorashl,Amar Elmustafa DL/ID: 549AG7752
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:
;.FlaCtf Alib
yW 7/26/2013
it,LT IOWA 'Yr
a eCa
s\D. O. T
SAWN qt. > Office of Driver Services
�It F
rin�,„ � Iowa Department of Transportation
Name: Elgorashi,Amar Elmustafa DL/ID: 549AG7752