HomeMy WebLinkAbout13-160 Authorization Number /,7 —/<<- C-
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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
(319) 356-5040
(319) 356-5497 FAX
First (( • Middle• Last
1. Name Z crAA �O.k? Yl l a.- G� G►ac Wr\
2. Mailing Address � 34 .r}�1 tq Aak , i\ Ic t_ock cAy N , Lj 2 ?-06
3. Telephone: Home Other: (3I q) �2 l ' ^,� �(2-
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4. Prior experience in transportation of passengers: 2- Yee(
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? N c_
Type of offense Where When
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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
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? „L\C%
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)
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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)
deddtaxidrivbadg 03/2013
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I here certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number.
Z'iv g, '? "'f . 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) p
Signature of Applicant 2 v l Date J(. \ r 3 0/ (3
STATE OF IOWA )
COUNTY OF JOHNSON )
Substiribed and sworn_ to fore me by Z'i� n e_tGL Fj04 + n6:7_)6t— - r'�On this 1B�-' —� day of
-'',A`s KELLIE K.TUTTLE Notary Public in and for the State of Iowa
1 . My Co missI E,)cpires
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********************************************* * **** *******************************************************************************************
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).
,,_ _iii
Signa 4 re of P. c fief 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.
` 1V11"-e: 7,c-- t-) . - rl. _ /3
Signature of City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width)and 51/2"
(height)and prominently displayed to all passengers.
************************************************************************************************************************************************
Office Use Only
Approved application
DCI report
State certified driving record
Website update
c erkRaxidrivbadgeapp2010.doc 03/2013
Ju:]. 18. 2013 4: 23PM. •".(Div of Criminal Investigation - '-. 4No. 9715 PP. 4/4
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Received Time Jul. 16. 2013 3;33PM,No, 9312 141 I .
Iowa Department of Transportation
4,1.1111111 Office of Driver Services (Toll Free)800-532-1121
PO Box 9204,Des Moines,IA 50306-9204 515-244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 7/30/2013 DL/ID#: 408AF2348 (IA) Customer#: 5591494
Name: Gasim, Zainelabdin Bala Class: D ID Status: None
Address: 2534 BARTELT RD APT 1A Audit#: 6474567 DL Status: VAL
Issue Date: 11/16/2012 CDL Status: None
City/State: IOWA CITY,IA 522462721 Expiration Date: 09/09/2015 CDL Cert Status: None
Endorsements: 3 CDL Med Status: None
Mailing Address: 2534 BARTELT RD APT 1A Restrictions: NONE Restriction None
Date of Birth: 9/9/1983 Supplement:
Mailing City/State: IOWA CITY, IA 522462721 Sex: M
History Information
Convictions
Citation Date Conviction Date ACD Explanation County JUR
04/17/2010 05/05/2010 593 Speed Johnson IA
05/02/2010 06/02/2010 M75 Passing School Bus Johnson IA
10/22/2010 12/05/2010 S92 Speed Johnson IA
12/28/2012 01/24/2013 E34 Defective Lights Johnson IA
Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date Case Number JUR
04/17/2010 570176 IA
11/16/2011 660394 IA
Name: Gasim, Zainelabdln Bala DL/ID:408AF2348
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