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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 Cit Iowa 52240-1826
(3T9) : Fr--; 4'�..2—I
(319) 356-5497 FAX
First --,— ^ Middle Last
1. Name iJ a kel detil( Z,hies cm,
2. Mailing Address �1/( id S+ 2 Co q(lel«-e , /4 , 5z1--//
3. Telephone: Home :31c1 - .35 I - 1266 Other:
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
A 0
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where When
Il
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)
110
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)
clerWlaxidrivbadg 03/2013
gi3,F2 V97
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
-1u._c:,). Ji,,\\\icksscori, . 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 , = Date ' -2 ° ' 03
************************************************************************************************************************************************
STATE OF IOWA )
COUNTY OF JOHNSON )
Subtscribed and swprn to before me by J c.* I .,Cc1 /) / 4-S- 6?--7-> . On this ` day of
hPO4, KELLIE K.TUTTLE / � G (l C P .
Commission Limb r 221819 Notary Public in and for the State of Iowa
• My o r n xpi es
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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).
.y—
' G-90 - / 3
a r olice 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.
72 .4 z— ,/,e • 4,4.4_, /3
Signa htre of City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/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
cleri taxidrivbadgeapp2O10.doc 03/2013
•
Department of Transportation
0-111Iowa
office of Driver Services (Toll Free)800-532-1121
FO Box 9204,Des Moines,IA 50305-9204 515-244-9924
FM:515-239-1837
,‘14111111110
•
Certified Abstract of Driving Record
•
Inquiry Date: 6/6/2013 DL/ID#: 463AF2497(IA) Customer#: 5402245
Name: AI-Hassan,Julia Medani Class: D ID Status: None
Address: 2401 HIGHWAY 6 E LOT Audit#: 4632497 DL Status: VAL
3801 Issue Date: 08/27/2010 CDL Status: None
City/State: IOWA CITY, IA Expiration 10/06/2015 CDL Cert None
522406823 Date: Status:
Endorsements: 3 CDL Med None
Status:
Mailing Address: 2401 HIGHWAY 6 E LOT Restrictions: Corrective Lenses Restriction None
3801 Date of Birth: 10/6/1975 Supplement:
Mailing City/State: IOWA CITY,IA Sex: F
522406823
History Information
CLEAR DRIVING RECORD
Name:Al-Hassan,Julia Medan' DL/ID:463AF2497
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:
.......
�4% ....AS 6/6/2013
IOWA •m''1
ist.D. O. T. eg
%4yFpf••...••'We Office of Driver Services
ay"weals— Iowa Department of Transportation
Name:Al-Hassan,Julia Medani DL/ID:463AF2497
Jun. 19. 2013 10: 11AM Div of Criminal Investigation • . No. 7492 P. 1
Juq. 1 /. 2013 11 : 39AM' �ity ..tlerk elty o•t lov;a GI [}'• No. r.))/ P. l • •
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