Loading...
HomeMy WebLinkAbout14-181 Authorization Number I q--1 p l — 1 (Office Use Only) 41. amoniczir ��— APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE 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 (319) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name IDRiS HMEL Lt.ATI F ILPis 2. Mailing Address 60 \ vJes-rwl V\cs. 10'A— C1T1 IA 3. Telephone: Home Other: 3 19 4- r r7 S 6 5.7 4. Prior experience in transportation of passengers: � C�� c,L. �S C�V 1 V 0 1 —' 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /1/0 Type of offense Where When 6. Have you beep convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? ^r'C • 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/C- 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) clerk/taxidrivbadg 03/2014 •r J 11 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 5 47 AG, 5b 67 . 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 �C�K Date (5 /A'S/I P 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 to before me by . cQ rt S A- �I%&(i . On this a?,.50,t_ day of . ,u ' Lid `!. 6,-41 rte WENDY S.MAYER o-ary Publica and for the State•. Iowa (nmrry��y,4Mu Y2a4tis My Commission Expires *********************************** *****,,***********************+**************************************************************************** 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). E37/2„3 / ,/ Signature of olio r� 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. Signare�Clerk or designee Da e 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 clerWlaxidrivbadgeapp2014.doc 03/2014 /Aug. 14. 2014 3:55PM (Di)/ of Criminal Investigation NNo. 7421 p,P. 41/1 ..� ins% STATN O10WA .� JJ bWt \ � �8 HrI p] Check .t.)-125,0\•••g'„ • 'ail" JZ ., `' 'RG/ uest Form ll \SaKFuos: • . • DCI Account Number: t•/nr)g---- (If applicable) To; Iowa Division of Criminal Investigation From: City of Iowa City . Support Operations Bureau,lreFloor City Clerk's Office • 215 E.71a Street 410 E.Washington Street Des Moines,Iowa 50319 • P5)12.5-6066 Iowa City, IA. 52240. ' (515)725.6030 Fax . Pyrone: 319-356-5041 Fax: 319-356.5497 • I am requesting an Iowa Criminal Histoi_Record Check on: • Last Name (mandatory) First Name(mandalosy) Middle Nance(rtcomnsendcd) IDMS 1 bAkS A1rFLGhT (P- Date of Birth(mandatory) Gender(=salary) Social Security Number(recommended) 03 r- 0,Li- — (' 54 Mgale Dk'emale t9i'S 63 9-564- . . -564- . Waiver Information:Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Code of rem)Chapter 692,2.For complete criminal htstoty record information,as allowed by law,always obtain a waiver signature from the subject of the request. Waiver Release:rhereby glvepermission for tho abovo requesling(inlet lo m40fin Iowa criminal bistoiy record cheek with Ilic Division of Cdre hal • investigation(DCO. Any ctiminal Ilium dela coneemin3nit diet ismein'bled byiheDClmaybeteleaiedasallmeedLylaw. Iowa Criminal History Record Check Results . ( tetL cop ase only) :. • As of 7C I l`"\ ' , a search of theprovided name and date of birth revealed: r.•,:', -, ? ✓ No Iowa Criminal History Record found with DCI • . •El Iowa Criminal HIstory'Record attached,DCI# DCI initials Received TirnerAug. 12. .02014 3:39PM No. 6866 r-p • SMARTER I SIMPLER I CUSTOMER DRIVEN" www.iovvado .gov Office of Driver Services PO Box 9204 l Des Moines,LA 50306-9204 Phone:515-244-9124 r 800-532-11211Fax::515-239.1837 wwwiawadoLgov Certified Abstract of Driving Record Inquiry Date: 8/12/2014 DL/ID#: 547A05067(IA) Customer#: 5872807 Name: Idris,Idris Abdellatif Class: B ID Status: None Address: 601 WESTWINDS DR Audit if: 5714153 DL Status: VAL Issue Date: 12/30/2011 CDL Status: VAL City/State: IOWA CITY,IA 522462755 Expiration 03/24/2016 COL Cert Status: Non-Excepted Interstate Date: Endorsements: PS CDL Med Status: Certified Mailing Address: 601 WESTWINDS DR Restrictions: Corrective Lenses Restriction None Date of Birth: 3/24/1956 Supplement: Mailing City/State: IOWA CITY,IA 522462755 Sex: M CDL Medical Examiner's Certificate Certificate Specifics ..� Explanations— Medical Examiner First Name Claudia �� Medical Examiner Middle Name _ 'Lynn Medical Examiner Last Name ,_ Corwin Medical Examiner License Number ...___ :29261 Medical Examiner Jurisdiction iIA Medical Examiner Phone ;(319)356-3335 Medical Examiner Type ,Medical Doctor Medical Certificate Restriction 1 .n.___ Wearing corrective lenses Medical Certificate Issued Date __ __ _µ„ _ !11/19/2013 T— mm —_„ ---- Medical -_,_Medical Certificate Expiration Date 11/19/2014 Date Added to CDLIS Driving Record - •12/11/2013 History Information CLEAR DRIVING RECORD Name:Idris,Idris Abdellatif DL/ID:547AG5067 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: =e tw 11b% "or' •80 8/12/2014 I'' : IOWA' a, icio p''1��'kin©BN $ Iowa DepartmenteeofiTransportation