HomeMy WebLinkAbout13-034-4
CITY OF IOWA CITY
410 East Washington Street
Iowa City. Iowa 52240-1826
,�-31 356-5040) n '//5-
(3T9) 356-549j
/IS(397)-356-5497 FAX
1. Name
2. Mailing Address
Authorization Number
/�;-3LI
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
Middle
3. Telephone: Home?� �3�Z� I �1 Other:
4. Prior experience in transportation of passengers:
Last
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
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense
Where
When
When
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)
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)
aenvta dd.dg 09/2012
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
} I ) 4 E:3 1 "3 a . 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
Date_L ( q
STATE OF IOWA )
COUNTY OF JOHNSONI
i ed and s or t) before me by So" i -pa 1 cle i VL �Y�h` On this day of
_77
Public in and for the State of Iowa
Y
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).
Signa ur of Police Chief or designee
2 2.2-/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.
Signalure 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
-aa-13
Date
deM idnvbadgea,,,M10d 09/2012
Iowa Department of Transportation
CAO
r 'f Office of Driver Services (Toll Fre) 80a-532-1121
PO Box 9204, Des Moines, ]A 503W9204 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
2/20/2013
DL/ID #:
422AF7170 (IA)
Name:
Ibrahim Mohamed,
Class:
D
CDL Med
Saifaldein O
Status:
Office of Driver Services
Address:
2401 BARTELT RD APT
Audit #:
5748482
2C
Issue Date:
01/19/2012
City/State:
IOWA CITY, IA
Expiration
05/13/2015
522462701
Date:
Endorsements:
2
Mailing Address:
2401 BARTELT RD APT
Restrictions:
NONE
2C
Date of Birth:
5/13/1960
Mailing City/State:
IOWA CITY, IA
Sex:
M
522462701
History Information
CLEAR DRIVING RECORD
Name: Ibrahim Mohamed, Saifaldeln O DL/ID: 422AF7170
Customer #: 5609235
ID Status: None
DL Status:
VAL
CDL Status:
None
CDL Cert
None
Status:
CDL Med
None
Status:
Office of Driver Services
Restriction
None
Supplement:
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:
_ ......... ..!,/
2/20/2013
IOWA'*'
10. T.
�9N[i S`
Office of Driver Services
Iowa Department of Transportation
Name: Ibrahim Mohamed, Salfaldein 0 DL/ID: 422AF7170
Feb.22. 2013 8:50AM Div of Criminal Investigation No,4170 P. 2/2
RAH. 2013 8:49AM City Clerk — City of Iowa City No,3222 P. 2
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