HomeMy WebLinkAbout13-152 Authorization Number 13 15
_ 1 (Office Use Only)
Crgraivcw
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 Cit , Iowa 52240-1826
C j319j 356 5040�� 7//c1
(319) 356-5497 FAX
First � Middle Last
1. Name /�/�� , �Z,f✓� �v 5
2. Mailing Address 1 514 P -y t 4-1 . I A 522_ c,1 (�
3. Telephone: Home 2. ...c1-71Y, Other:
4. Prior experience in transportation of passengers: Tu Xi A4 G kitP-cc ��,, a .i Y1
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? �0 J
Type of offense Where When
6. Have you ben onvicted 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? /L
Type of offense 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
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)
derk/taxidrivbadg 03/2013
/S"2 DV 7s3 s'
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
1 50-DP 1c 7 i. . 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)
Signature of Applicant .1\A oc .tc\i' __-__. -:,-e, Date 'Wig 1 13
***,,... ***************************************************************************************************************************************
STATE OF IOWA )
COUNTY OF JOHNSON ) t J. -+
Subs ibed. and sworn t before me by i� �O C` ��V`i r -1- Cl f 5 On this � � day of
ii / �f
u';., KELLIE K.TUTTLE
C��rniccinn umb r 221816 Notary Public in and for the State of Iowa
f My Coto fission /
xpires
s`Y
************************************************** *********************************************************************************************
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).
r.,
,,
igna ure of Police 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.
22 �z-u � k • 7�"�•,�, 7-,?ii-i,
Sign ure of City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/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
clerk/taxidrivbadgeapp201 O.doc 03/2013
IowaDriver Department of Transportation
r,4„ Office of car Services
PO Box 9204,Des Moines,IA 5030G 9204 515-244-9124
FM:515-239-1837
Certified Abstract of Driving Record
DL/ID it: 152DD7535 (IA) Customer#: 4336110
Inquiry Date: I7dris, Modathir/2013 D ID Status: None
Idris, Class:
Name: DL Status: VAL
Address: 1514 ABER AVE AudIssuet#:D04/20 2 CDL Status: None
Issue Date: 04/20/2012 CDLrt None
CCe
City/State: IOWA CITY,IA Ce
Expiration 03/05/2017 Date:
522464702 CDL Med None
tatus:
Endorsements: 3 •
Status:
Restriction None
Mailing Address: 1514 ABER AVE Restrictions: NONE Supplement:
Date of Birth: 3/5/1958
Mailing City/State: 024647TY,IA
Sex: M
02
History Information
CLEAR DRIVING RECORD
Name: Idris, Modathir DL/ID: 152DD7535
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:
ca.'''017 0 , 7/23/2013
p,,4�0••....• gEa*Jl Office of Driver Services
yfif aim Iowa Department of Transportation
Name: Idris, Modathir DL/ID: 152DD7535
Ju•l.'16. 2013 11 : 31AM •• Div of Criminal Investigation gNo. 0343 . P. 1/6
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