HomeMy WebLinkAbout13-062r Authorization Number /3-69,
= 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 City, Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
1. Name
2. Mailing Address 2tioi R4.teit j?d, ft)WQ Crty IN 6_2z=-6
3. Telephone: Home 9co — i Io Other:
4. Prior experience in transportation of passengers: ,ni o
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? rJ o
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
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where When
8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? f -k D
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)
nJ D
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)
derWt dr b dg 09/2012
r/
I heret L certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
(Z} A t i /i S�S� . 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) Kt,
Signature of Applicant Date C4o"� 13
*##Y#+##R####R***f**f**Y**##*####R**Y**Y*f*f#++#+###********Rff*4Y4############R****#4*1fY*1rtf#ff+M#+#####********lffM4##t##tk###**f*f*Y+Y#+++
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to=0btrr7"
On this / day of
Ma r r 7 O/ �IF6Notary 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 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`'�--
Signet a of Police Chief or designee
TX�113
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 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
oletl &TvbadgeaW2010,r 09/2012
ARTS
Page 1 of 1
Iowa Department of Transportation
AO Office of Driver Services (Tdi Free) SM -532-1121
PO Box 9204, Des Moines, IA 503@5-9244 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
3/7/2013
DL/ID #:
567AG4388 (IA)
Customer #:
5906191
Name:
Badry, Badr Taher
Class:
D
ID Status:
None
Address:
5635 KIRKWOOD BLVD
Audit #:
6711719
DL Status:
VAL
. SW APT 4
Issue Date:
02/20/2013
CDL Status:
None
City/State:
CEDAR RAPIDS, IA
Expiration
12/16/2016
CDL Cert
None
524045200
Date:
Status:
Endorsements:
3
CDL Med
None
Status:
Mailing Address:
2509 BARTELT RD APT
Restrictions:
NONE
Restriction
None
1B
Date of Birth:
12/16/1986
Supplement:
Mailing City/State: IOWA CITY, IA
Sex:
M
522462715
History Information
CLEAR DRIVING RECORD
Name: Badry, Badr Taher DL/ID: 567AG4388
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.
Ih 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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3/7/2013
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Office of Driver Services
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Iowa Department of Transportation
Name: Badry, Badr Taher DL/ID: 567AG4388
http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 3/7/2013
Sep,12. 2012 10:35AM Div of Criminal Investigation No.3767 P. 4
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Yreslv$olnas,To\YA 50319
(5 15) 729-A 66 XO'VA CITY TO'G'A 52240
(51S} q?le-6090 l+ox
Phone; 919-456-5041
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❑ rorua CUnfna1 Hiatoryl2000r'd attached, DCI*
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Received Time Aug. 31. 2012 MUM No.,2577
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