HomeMy WebLinkAbout13-154 Authorization Number
I rL 1 (Office Use Only)
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 C—it�, Iowa 52240-1_826
2'1 ) 35 6-5.049 ('?o,, 11
(319) 356-5497 FAX
First Middle last
1 Name +6 hGL rt -e rL5r� c',,1 ! D '('cx-. '�/l.I,WI
2. Mailing Address 25 o ea, r- t let- R S `.t o W L C vi-k__)1 0°0/et
3. Telephone: Home Other:/56) t<5761
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
No
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
1\
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where When
tiD
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
Type5\ of offense Where When
1`tt, m
C7"4C
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pro he Mme(
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DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE G'CRTIFI _
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR-POLICE CHIEF RE1W
You must apply for an individual Department of Criminal Investigation Report(form available upon request).
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
derkltaxidrivbadg 03/2013
1
I hereby cert' t I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
L/5 7 V V 66 Ig . I understand that if I falsely answer any questions in this application, that this
app'cation 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)
Signature of Applicant _ Date 7/2 / t
STATE OF IOWA )
COUNTY OF JOHNSON ) / J
Subscribed and sworn to before me by �jv,y�e, 17.c d �,ia {�i14t On this �(�O day of
jee.Z7/, -,2 ;'/
XY
Notary ublic in and for the State of Iowa '.-z3 I,
****************************************************************************************************************.*******************************
I have reviewed this application, DCI report, and the Statt 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).
H/26 '/ 3
Signature of olice Chief or designee !! Dafe
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 or the city website at icgov.org.
7 `�Gutu/ t L - _2 " /
Signature of City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 51/2"
(height)and prominently to all passengers.
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DCI report
State certified driving record
Website update
clerWtaxidrivbadgeapp2010.doc 03/2013
Jul. 11. 2013 12:49PM Div of Criminal Investigation •, 9894 P. 1/1
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Received Time Jul. 9. 2013 1 :42PM'' o 95601- •
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Iowa Department of Transportation
ciii Or
Office of Driver Services (Toll Free)800-532-1121
PO Box 9204, Des MoinIIII
es, IA 50306-9204 515-244-9124
gilliP FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 5/15/2013 DL/ID 4t: 257DD6818 (IA) Customer 44: 4350508
Name: Ibrahim,Mohamed Class: D ID Status: EXP
Elsadig
Address: 2504 BARTELT RD APT Audit 44: 6217135 DL Status: VAL
28 Issue Date: 08/15/2012 CDL Status: None
City/State: IOWA CITY, IA Expiration 09/02/2014 CDL Cert None
•
522462714 Date: Status:
Endorsements: 3 CDL Med None
Status:
Mailing Address: 2504 BARTELT RD APT Restrictions: NONE Restriction None
28 Date of Birth: 9/2/1979 Supplement:
Mailing City/State; IOWA CITY, IA Sex: M
522462714
History Information
Convictions
-it - C"_ • on.N n..e :ate .1CD E xp anation County NUR
04/12/2009 04/29/2009 M81 Careless Driving 78 IA
04/12/2009 04/30/2009 592 Speed 78 IA
05/18/2012 08/28/2012 S92 Speed 52 IA
09/29/2012 11/06/2012 592 Spe°0 52 IA
Name: Ibrahim, Mohamed Elsadig DL/ID: 257DD6818
Pursuant to Iowa Code§321.10, I, Kim Snook, Director of Office of Driver Sevices, 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:
VENlelf p"a,
/4' 5/15/2013
$3fl
,f.t,: : og a ejefook?
Office of Diver Services
q\"ORIIItH,= Iowa Department of Transportation
Name: Ibrahim, Mohamed Elsadig DL/ID: 257DD6818
5/15/2013