Loading...
HomeMy WebLinkAbout14-198 • Authorization Number I 1 (Office Use Only) avionarir APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m.to 3 p.m., Monday—Friday.) 410 East Washington Street Iowa City, Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX FirstMiddle Last 1. Name (REQUIRED) '\OJarr�AN-; 2. Mailing Address (REQUIRED) ' S 14 R �� v fa t C ul A c 6.) y S2 3. Contact Information (REQUIRED) Email: P �i U c,S i p cVyl Qty•(owl Cell Phone: 3)9 — S12---T-116 4. Prior experience in transportation of passengers: 3 ,eaF 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 r(/ years? A`d Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? /j/j7 ) Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? {/J 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) Aid 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) 09/2014 r I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number i 5 2 U'L .-) S Z . 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 / l G Q Date 1 ki ) ) LI 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. STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn o before me by M� � �1 rQA� f 14.)r r . On this t-,l day of ii• ,' 14. S " 'I AYER itNoti. Commission Number 729428 (� A. .., S r4e.___ • My o mil-on Expires ary F�`alic in ar for the State of to low / ************************************************************************************************************************************************ 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). .' / - iy Sign ure of P,�`c. Chief 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. 7)1V/•(--G/11"1--/ '\1-1- - ,--,,--4..) e- x/i-/ z SignAtre of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width) and 51/2" (height)and prominently displayed to all passengers. *****************************",,,, *********...,,.*************************************..-***************************************************** Office Use Only Approved application DCI report State certified driving record Website update Clerk/TAXIDRIVBADGEAPPL92014amended.DOC 09/2014 ISep. 2. 2014 12: 21PM ('Div of Criminal Investigation ,,No. 9057 r1P. L1 f%U 5. L I T J "r J l lv IJ I L y V 1 4 1 A V I I J V I I V 110. V I .l • �f. • STATE OFIOWA • mfa 4 . w\ � " til ACirn>raanna29 History RecordCheck5 `. :: . •:: Ivtowev: l; r--! Reaped Form r�?\1 , atiN AC'Account Number: Y . -g- Orappllablc) To: Iowa Division of Criminal Investigation From; City of Iowa CitY Support Operations Bureau,1"Floor City Clerk's Office 215 E.7"'Street 410);.Washington Street • Des Moines,Iowa 50319 (515)7254066 Iowa Ctty, IA 52240 (515)725-6000 Fox • Phone; 319-356.5041 1 ax; . 3194563497 I am requesting an Iowa Criminal HistoryRecord Check on: ' Last Name (mandatary) First Name(waken)) :IVltddle Namesreeommendea) 1ar\s Moa-svir • Date of Birth(mandatoryt Gender(mandatory) Social Security Number(recommended) 03 — os— Se) 0.1VIale °Female I ai sW - 9611 • Waiver Information:Without a signed waiver from the subject of the request,a complete criminal history record may not . be releasable,per Code of Iowa,Chapter 692.2.For complete criminal history record information,as allowed by law,always obtain a waiver signature from the subject of the request. ' Waiver Release:l hereby give permission for the aboyc requesting official to conduct an Iowa criminal history record check with the Divisien of Criminal Investigation(DCI). Any criminal history data concctningme that is maintained by the DCI may be released es allowed by law. 1 Waiver Signature: ?AO.O — . t.—tet �p� Iowa Criminal HistoryRecord Check Results .(DCluseonly) •o As of / — a - /V , a search of the provided name and date of birth revealed: itici No Iowa Criminal History Record found with DCI ® Iowa Criminal History Record attached,DCT# •• ' pa II OCT initials 9. O . PArAiveO Time•..Aug. 25. 1,2014 3:48PM No. 7962 tit sit It I DOT wwwiiowadot:gov f!!? SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Driver Services P©Box 9204 I Des Moines,IA 50306-9204 Phone:515-244-9124 1800-532-1121 1 Far. 5115-39a1.gov 8 Certified Abstract of Driving Record DL/ID#: 152DD7535 (IA) Customer#: 4336110 Inquiry Date: Idris,Modathir014 D ID Status: None Idris, Class: Name: DL Status: VAL 1514 ABER AVE Audit#: 04/20 2 CDL Status: None Address: Issue Date: 04/20/2012 CDL Cert None IOWA CITY, IA Expiration 03/05/2017 CDL Ce City/State: 522464702 Date: CDL Med None Endorsements: 3 Status: Restriction None Restrictions: NONE SupplementMailing Address: 1514 ABER AVE Date of Birth: 3/5/1958 Mailing City/State: IOW 64702 A CITY,IA Sex: M 52 History Information CLEAR DRIVING RECORD Name: Idris, Modathir DL/ID: 152DD7535 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Cffice of Driver Services, Iowa Departmtrueent of Transportation, do d by ffice of hereby alae that I am the custodlan of the records in the custody of said office,and that eIOhave been authorized by thiver Services, e Dirlectos is rof the IowacDepartment of Transportation to so certify. Iowa In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, this date: Etllilf Flu Q.V pIO��y48/26/2014 Pe-71 IOWA 10 D. O. T. iiler�......•/%O'� Office of Driver Services 9 x.,. nitR, Iowa Department of Transportation • Name: Idris, Modathir DL/ID: 152DD7535