HomeMy WebLinkAbout13-024r
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CITY OF IOWA CITY
410 East Washington Street
Iowa Cil 52240-18'�i� i 1
9) 356-S040 /�"1
(319) 356-5497 FAX
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday - Friday.)
(Office Use Only)
Middle.._ Last ���? /� � n �
1. Name k I R � 7 � at+jI t A I? t� 8qe
2. Mailing AddressZ L�C(Y t�j - TI L -16 A-ty L 4" / -14
3. Telephone: Home Other:
4. Prior experience in transportation of passengers:v jef
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5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? lU 0
Type of offense Where When
6. Have you begin convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?_ , b
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 driver's license or chauffeur's license been suspended or revoked in the last five years? N 6
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)
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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)
d� dnVbsdg 09/2012
I hr certify that I have is
ed to me by the Iowa Department of Transportation a valid Chauffeur's license humber
Mc
T b . I understand that if I falsely answer any questions in this application, that this
apple on may W 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 ! YO` N i n Date Z ,12, �-+' I
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STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by On this 1 kh day of
No Public in and for the Sta ofof logia
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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).
Signa ty a of PO;
hief 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.
l �' ICt'-c.Gee7�C:CiL�
gn a 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
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Date
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Received�TimesJan`. 17. 2013 10:52AM No.0161
Iowa Department of Transportation
Office of Driver Services (Tull Free) WO -532-1121
130 Box 9204, Des Moines, to 503D642134 515-244-9124
FAX: 515-239-1837
Inquiry Date: 1/17/2013
Name: Abbashar, Yasir Ibrahim
Address: 2401 BARTELT RD APT 1C
City/State: IOWA CITY, IA 522462701
Mailing Address: 2401 BARTELT RD APT 1C
Mailing City/State: IOWA CITY, IA 522462701
Certified Abstract of Driving Record
DL/ID #: 65SAIS404(IA)
Class: D
Audit #: 6585404
Issue Date: 01/03/2013
Expiration Date: 04/29/2018
Endorsements: 3
Restrictions: NONE
Date of Birth: 4/29/1972
Sex: M
History Information
CLEAR DRIVING RECORD
Name: Abbashar, Yasir Ibrahim DL/ID: 658AI5404
Customer #:
6051382
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
Page 1 of 1
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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1/17/2013
IOWA
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D. O.T.:e;
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Office of Driver Services
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Iowa Department of Transportation
Name: Abbashar, Yasir Ibrahim DL/ID: 65BA35404
1/17/2013