HomeMy WebLinkAbout13-066r 1 r
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 3S6-5040
(319) 356-5497 FAX
First
1. Name TH ift
Authorization Number 13-106
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
Last
2. Mailing Address ja0l Al Iz��stgm / C__94f Ur. LLL r I H
3. Telephone: Home Mg- ri7`Z— 3$x59 Other:
4. Prior experience in transportation of passengers: -7�cik_ ct f—AV Cr
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Tvpe 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?_ Me
Type of Offense
Where
7. Have you been convicted of any traffic offenses in the last five years?
Tvpe of offense
Where
When
When
IIIf17,Jo
8. Has your drivers 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 bean 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)
clerkAaxidrivbadg 09/2012
Q
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
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 p1cJN, Date -31 1917aig
h#+*#4***##*#F##FFF#*FFFF#Fh*F******####**##*++##+##***##*###*#4*#***#*****#*#*#*#*#***********************F***FF*FF*F*h*#*###*#Y#***#*##*##*#+#
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by ) cel.. r a.5 On this 1 day of
?o L
o SONDRAE FORT
z Commission Number 159791
My Commission Expires Notary Public in and for the State of Iowa
I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter-
mined that :; rare 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).
i natug'of Police Chief or designee
S� 3
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.
Sign re of City Clerk or designee
Taxi cab businesses are required to provide Driver Identification cards.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
%/3
Date
cleM1Jt drivbadgeapp2010.doc 09/2012
Iowa Department of Transportation
I!' , Office of Driver Services (Toll Free) 1100-532-11211
PO Box 9204, Des Moines, IA 503011-9204 515-249-91277
FAX: 513-239-1537
Certified Abstract of Driving Record
Inquiry Date: 3/8/2013 DL/ID #: 523AG2892 (IA)
Name: Bashir, Tahir Mohamed Class: D
Ahmed
Address: 1001 N BOSTON WAY Audit #: 5232892
Issue Date: 05/18/2011
City/State: CORALVILLE, IA 522413116 Expiration Date: 01/07/2016
Endorsements: 3
Mailing Address: 1001 N BOSTON WAY Restrictions: Corrective Lenses
Date of Birth: 1/7/1973
Mailing City/State: CORALVILLE, IA 522413116 Sex: M
History Information
Convictions
Customer #: 5833128
ID Status: None
DL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
Citation Date Conviction Date ACD Explanation County 3UR
11/20/2011 12/09/2011 A14 'Fall to Obey Traffic Sign/Signal j52 '.IA
Name: Bashir, Tahir Mohamed Ahmed DL/ID: 523AG2892
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:
Name: Bashir, Tahir Mohamed Ahmed DL/ID: 523AG2892
3/8/2013
Office of Driver Services
Iowa Department of Transportation
Mar. 14,
20133 2:29PN�
Div of Criminal Investigation
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Received TimewMar, 8.`2013— 2:48PNrh'o, 5841