HomeMy WebLinkAbout13-073CITY OF IOWA CITY
410 East Washington Street
Iowa Cit , l—o_wa 52240-1826
{3 91Y 356-5040 f,C�Y'G�)'3
(319) 356-5497 FAX
Authorization Number /3— 73
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
Aaka to
(Office Use Only)
R se;`� � ��� t+, 1 t� a,wr
1. Name ;
2. Mailing Address tkAkis ie f'N Froo rtq pt% -Q Loa. of-z,t� SZ
3. Telephone: Home Other: o Z4 / S 13 rl
4. Prior experience in transportation of passengers:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? M ej
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? H C
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? / 4 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? %L 0
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) The re-
port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli-
cation.
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
demrtax:drivbad9 09/2012
It
I hereb certify that l have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
b 6� 4 (� �1 To o d . 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 O3_I
STATE OF IOWA )
COUNTY OF JOHNSON )
SugscTib�d and worn to be e me by /4 Ste" ' (� ����/ On this �'�� day of
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).
gnatur 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.
Signature of City Clerk or designT
Taxi cab businesses are required to provide Driver Identification cards.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
-�7- i'6
Date
deWtawdr[v WgeaW2010tl 09/2012
Name:
Makawl, Asaad Suliman
Class:
C
Address:
2507 WHISPERING PRAIRIE
Audit #:
6697600
CDL Med Status:
AVE
Issue Date:
02/14/2013
City/State:
IOWA CIN, IA 522406725
Expiration Date:
04/12/2018
Endorsements:
NONE
Mailing Address:
2507 WHISPERING PRAIRIE
Restrictions:
NONE
AVE
Date of Birth:
4/12/1963
Mailing City/State: IOWA CIN, IA 522406725 Sex: M
History Information
CLEAR DRIVING RECORD
Name: Makawi, Asaad Suliman DL/ID: 669AJ7600
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
Iowa Department of Transportation
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:
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2/26/2013
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Office of Driver Services
Iowa Department of Transportation
Name: Makawi, Asaad Suliman DL/ID: 669AI7600
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Received Time—Mar, 6.-2013-12;28PM—No.6428
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