HomeMy WebLinkAbout13-054Authorization Number / 3 _5+
(Office Use Only)
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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 3�4 56-5040 _ Sys
(319) 356-5497 FAX
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday – Friday.)
First Middle Last
1. Name _M /1blAr.at�n.. — TRAC)Re-
2. Mailing Address CLJ' 14,1-ir'sp–CRi1V9 pQa:R(E AV4 XZU A rA rA,�_LIO
3. Telephone: Home 3/`I CAI - bSES-- 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? pa A n/
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? rvla vv
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? t,
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? r,,AA}Li
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) N&I
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)
de ta.iddiW dg 09/2012
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license nunfber
g9eZ Z --Qm. 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 'RA2!([ �N�ropl1c ti Date / � G )3
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STATE OF IOWA )
COUNTY OF JOHNSON )
S bscribed and sworn to before me by �)N 4�f\,wc , opt �� qor 'e y On this day of
4/QV' -')0(-s \ i -
in and for the State of Iowa 13 [ Iy
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).
A�
'Bignat a of Police Chief or designee
1/�i�� 3
I - 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
Date
deriNavitlmba4gea,2010 tl 09/2012
Mar. 1,
2013
8:51AM
Div of Criminal Investigation
"Feb. 25,
2013
1:52PM
City Clerk - City of Iowa City
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Page 1 of 1
C
Iowa Department of Transportation
Office of Driver Services (Coll Free) 800-532-1121
FO Box 9204, Des Manes, IA 50306-9204 515-244-9124
FAX: 515-239-1937
Certified Abstract of Driving Record
Inquiry Date:
2/21/2013
DL/ID #:
96OZZ5901 (IA)
Customer #:
362217
Name:
Traore, Mahamadou
Class:
D
ID Status:
None
Address:
2547 WHISPERING
Audit #:
6110052
DL Status:
VAL
;Speed
PRAIRIE AVENUE
Issue Date:
07/10/2012
CDL Status:
None
City/State:
IOWA CITY, IA 52240
Expiration
07/08/2017
CDL Cert
None
Date:
Status:
Endorsements: 3
CDL Med
None
Status:
Mailing Address:
2547 WHISPERING
Restrictions:
NONE
Restriction
None
PRAIRIE AVENUE
Date of Birth:
7/8/1978
Supplement:
Mailing City/State:
IOWA CITY, IA 52240
Sex:
M
History Information
Convictions
Citation Date
Conviction Date
ACD
Explanation
County ]UR
04/22/2009-05/19/2009
.592
Speed
r52 IA
10/07/2009
{01/27/2010
S92
.Speed
52 IA
09/23/2012
110/19/2012
,S92
;Speed
.52 IA
Name: Traore, Mahamadou DL/ID: 960ZZ5901
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: Traore, Mahamadou DL/ID: 960ZZ5901
2/21/2013
2/21/2013
IOWA'*''E
s�
r "••"' Ste'
Office of Driver Services
a#RIO
Iowa Department of Transportation
Name: Traore, Mahamadou DL/ID: 960ZZ5901
2/21/2013