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Home My WebLink About15-055CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX 1. Name (I'w EQU1I1111RE J . 2. Address (RE()UIRI::",I',,t) uIMEN (iiRCA1 u0N iNO( (tuft ce Use Only) APPI...IICK1110N FOR TAXICAB f MO"t 0111IZEI D PEIMCAB VEII IIICILIEW DRIVER (PoMm Department ireviiewimnu s.1, be imnade between 6 a.mn„ to 3 pan., Monday ••••• Friday) /�•, /llll�ll llllflllllullr/lIr l�/eIf N�I,III /E ;'/I//Il%�� ,l ,. ,,,,, , 3. Contact Information REI UINI1P ILEitta'll:o 1.0 4 h CelllPlh�oin�a: (AII wmftten comimunicaboin sena coria einaill) 4a. Chauffeur's License expiration date (I'k b. Taxicab Business Name (R .: l.plR1:::D) 5. i'doir experience 'In transportaboin of ps 6. Have you ever been arrested /charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense iA(her. When i What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7 Have you been arrested / charged with any traffic offenses in the last five yeaiz? 4,2 Mme. ype of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeurs license been suspended or revoked AL. iye, of offense Where mm 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) I:DEPAR'll"116MEENT OF CRIMINAL (INVESTG,f1"l"I0N (DCII REPORT AND STATE CIEKI] IED DRIIVp NG IRIECO RD MUST ACCObliPANY "I'lNIS APPII...ICArl0N 11::O R POLIVEE CI llEF REVEW You must apply for an i ndlAdnuall Department nt int' Crlmmiiinall linvestlgaUo n ikelport (Irormma avalllable upon irequest), (SECOND PAGE.:, FOR !SEOtUiREII:D SIGNA"ruRE AII9D INO9T'AIPY) N 02/2015 AI:'PICA"104 IN"t:Dll't "1"AXICAA VIIIIJI C111.JI'1. III°fI' IVIIIII]II'1 Page 2 I hereby certi hat I av issued to me by the Iowa DMMIL of Transportatio v Ili Chauffeurs license number rO�i q 0 issued on { I xpiring on . I understand that if I falsely answer any questions in this application, that this application may 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 authorization to be a taxicab driver 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'Appiiioant,,,,,,,,,,, 'A- �J ......................._........................._............................._..... Date *******[*^*k6*******#*#****4**##**ARik**#*#k****##ie****k*****k**#-k#4******#*********#****#**##****###*****i#**#ye*ik#*********#***i*A******M#****#*# STATE OF IOWA ) COUNTY OF JOHNSON ) me by on this _ day of iIn and fd'[l the State of Iowa I have reviewed this appiicadon, DCI report, and the State certified driving record of this applliicant and have deter- mined that there its no information which would !Indiicate that the issuance would be detrinnentall to the safety, Ihealtlu or welfare of residents of the City of Iowa City (TRW 5, Chapter 2, Cil Code). ............................. ..._ �®r ignature of Doli ignee iYate w. AFTER APPROVAL BY TlHl1 CITY CLERK YOU ARE AUTHORIZED 'TO DRIVE A TAXICAB IN NO@dkfA CITY FOR NO MORE THAN ONE YEAR i°11tOM TNIE DATE LISTED BELOW. THE EFFECTIVE DATE WILL MATCH THE CHAUFFEUR'S LICENSE EXPIRATION IF:: LESS 'THAN A YEAR. Signature of Ctky Clerk or designee Approved application DCI report State certified driving record Website update S Dak CteWrAXIDRrVBADGEAPPLU014ameM.d.DOC 02/2015 STATEOF1OVVA i History Recoird Check Request Form To: Iowa Dlvlsloa of Criminal investigation SnpportOperatioits Bureau, r'Floor .215 E. 714 Street Des Moines, Iowa S0319 (515)725-6066 (515)725-6080 Fox an Iowa Record C hook on: No. 1210 P. 1/1 we.9bbd Y. L DCIAccouatNurabee: ;-F (ICappli , 1a) From: Cft of Iowa Cites Cfly Cleric's Moe 410 Ea 2tllasltingtot� Styeei Iowa C"fty, 1� 5224® Phone: 919-356-5041 Far. 3119-3562497 WIN l iaa�s"fil r'' WWYeP ReleaSe: t hereby givepemiisslon fw0is above requalfng official to conduct an Towa criminal history record check with the Dlvlsion ofGYiminal Invasllgas(an(DCQ, Any criminal historydata concomingma lbot ltmainlained bylhe 1301 meybereleased at allu%Td bylaw. 41V9r � r>i iI1a1 isar �c� �h��1t eslzIts As ®f a $eabch of the provided name and date of birth revealed: I4o Iowa Crindnal History Reeord foalltd with DCI lows. Criminal History P-coord attaohed, IDCI TCI Infdais T�I T-77 0phSh01 Received lime eb, 25. '2015 2:06PM No, 1119 file! a :Dilly) I Feb.26. 2015.11:13AM Div of Criminal Investigation Fell. is, i u i ) L:vorM blly uierK — l.lry Or Iowa 6,Ty STATEOF1OVVA i History Recoird Check Request Form To: Iowa Dlvlsloa of Criminal investigation SnpportOperatioits Bureau, r'Floor .215 E. 714 Street Des Moines, Iowa S0319 (515)725-6066 (515)725-6080 Fox an Iowa Record C hook on: No. 1210 P. 1/1 we.9bbd Y. L DCIAccouatNurabee: ;-F (ICappli , 1a) From: Cft of Iowa Cites Cfly Cleric's Moe 410 Ea 2tllasltingtot� Styeei Iowa C"fty, 1� 5224® Phone: 919-356-5041 Far. 3119-3562497 WIN l iaa�s"fil r'' WWYeP ReleaSe: t hereby givepemiisslon fw0is above requalfng official to conduct an Towa criminal history record check with the Dlvlsion ofGYiminal Invasllgas(an(DCQ, Any criminal historydata concomingma lbot ltmainlained bylhe 1301 meybereleased at allu%Td bylaw. 41V9r � r>i iI1a1 isar �c� �h��1t eslzIts As ®f a $eabch of the provided name and date of birth revealed: I4o Iowa Crindnal History Reeord foalltd with DCI lows. Criminal History P-coord attaohed, IDCI TCI Infdais T�I T-77 0phSh01 Received lime eb, 25. '2015 2:06PM No, 1119 file! a :Dilly) I i, ,,v U DO T $gy LLNp qty{ �4w1w, YrV albri t4..A'ov aee f11 iry i.. 1� yp yy0YP fA 1il`Xu b :alf• _�4��« rC,H {'( j( fµµµ MX090NWIOFlItldIC1YmJ9➢p6NG ll4!! //! ➢eµyyu, 1009 Gffke o%[a*haaa,�WSaervi s PO Box IADes 4g... 4 F„s+y, ^,e'S9s244-9124; Fat'. 5'S -a.:`9-1351 ,t iisat dta'__gess. Inquiry Date: 3/4/2015 DL/ID #: 059AA0923 (IA) Name: Omar, Sawsan Khalil Class: D Address: 1001 N BOSTON WAY Audit #: 7358065 Restriction None Issue Date: 09/19/2013 City/State: CORALVILLE, IA 522413116 Expiration Date: 01/01/2016 :592. ,Speed Endorsements: 3 Mailing Address: 1001 N BOSTON WAY Restrictions: NONE Date of Birth: 1/1/1972 Mailing City/State: CORALVILLE, IA 522413116 Sex: F History Information Customer : 1559313 IDStatus: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement- .;peed OLAa an Date Conxirtion hate D 2.1; AanuU031 Couuttr^ 31f:.A 7. B/ft2f7071. 82!87(,70 B. B. M14 Tall to Obey Traffic Sign/..fgn'al � �Johnson 1A 06/23/20 i.2 _.. .._. 07/17/7017 _._.. _.... ... 597 _ ,.. .;peed Iohnsou _IIA -. O6f06l20:1.4 -O'7P2.f.P70.1.4 :592. ,Speed .. Jasper .. __.. =1A Accidents - Accident of , • ,., , ',C."'Wesp k��tfi L:F' G 1zS,4r;:bk'r tlfyY� o. 1.ffY✓/7D r.'xa6:,kllAs rn 04/20(2.0:1.4 ;7g k74tls .Po Name: Omar, Sawsan Khalil DL/ID: 059AA0923 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: Omar, Sawsan Khalll DL/ID: 059AA0923 3/4/2015 IOWA ': o '10 Office of Driver Services Iowa Department of Transportation