HomeMy WebLinkAbout15-054IDEN f FIICA...V DIN NO.....�
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(Office e Use Only)
APPIUCA"H ION FON "II'AMCAB d ANOTOIRVED PEDICAB VEHICLE DRIVER
C" F IOWA CITY (Police Department rrevIleww must Tse made between 8 a.mn to 3 Il Monday ••- FirVday)
410 East Washington Street
Iowa city. Iowa 52240-1826 1, 1UUu' t'Gr t �ntW�Ir1r lC Cl Pib-'/O3C�� Ir'L''r(;'I "1Y¢r�/Ilel )TCU4 Vr1Pr1106, ,!;i,6 til 111 k1€'n,(,e`Il ql'G!'ri a ,tU Vgrli
(3 19) 356-5040
(319) 356-5497 FAX
1. Name 'llwtll,;;QOVUV1gt 111 ... ..t1n q ) r� .... �U d
I U' 1 f rm gill' 3 tr a a:.w 1
( )1 -"
r n .. �l �°r �r_a c� � � t � 4e. �„�
2. Address V kII.11gUVII111 II'D (AVII m iiiltesn a �rruinmmmi¢asngoa..um =y..... ..m . mmNll Phone: . .,. u y
3. Contact Information �T . II II I V U ~ ., � .. .. ... i
99 vein enna ll)
4a. Chauffeur's License expiration date (gwll�glW110-q 9) ep p. 0 r? `.cm � (j
... ...................................................
b. Taxicab Business Name (I 11 a q.,Vlu 1lq,y .......,. , . .. ...-.
5. Prior experience in transportation of trona zseng er $ . ....... .,.. U� 1 :- _.......................................... _......................................... ...
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? _____PLO—
What
O
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty
7. Have you been arrested / charged with any traffic offenses in the last five years?
Type of offense Where
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty
Other 1 U
When
Other
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
yp;o gfgrferse Where When
.........................................................................................
9. 11 lave you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) 11f
0
DEPARTMENT OF CRIMINAL INVESTIGA'1fIlON (DCV) REPORT AND STATE CERTIIFlIIED
DRIVING RECORD MUST ACCOMPANY THIS APPLICA'1TnON FOR POLICE CHVEIF ffdIEVIEW
You must applly for an indlvVduall Department of Cel minall inves9gatlon Report (form available upon request).
(SECONID PAGE FOR REQ UlRED SIIGNA"11"LURE AND NO"ItAI?Y)
02/2015
APPiL.lICATi0ig i' lo -''."'IIIA Ka Ailii VEll11C91..1°IliIgRIM1111:ER.
ul.1age 2
I hereby certify that I have issued to me by the Iowa D9paqment of Transportation a valid Chauffeur's license number
U 2 >; issued on 0 I�rcpiring onc" o . I understand that if I
falsely any questions in this application, that this appli ation ay be denied. agree t at 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)
pp Nato.,... ....::°:'.� )..,
Signature aal'A Applicant ....................................... _..__...................................._...............................® .. �
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and swom to before me by JAtmgm%II..."� Pv(bm,.ttMratNr•;r•on this ,5,1k:,,,,,,,,,, day of
:aa.... Pak
<..P A� 0�
ff..,NOY S.MAYUK '..:................._.................................................................
.........
• , b9OW12A Kotary i�ai Ht� lin aarci for tine
*****££4********k***###*******k***A***4#***********Rh#4*4******A##4#*4******kkkk##4#*********kA*#**##*#*k***RkA*k*k##*££#d*4*4#£*#******k**#****
r . n
or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code).
Signature of PoiiC ie or designee
......................... .............I�................pp...................
[Dail.........................................................................
.
AFTER APPROVAL BY 'II CII'T'Y Cfl_IEI K YOU ARE AUT'II IICDIRIZ EIID TO DRIVE A TAXlCAB IIN 10WA CITY FOR NO
II "II'T-NAN GINE YEAR if FROM "II'111E IIDA"P'IE ILII""II"ED II3EIL43W
'111-111-H Ei"ill"'If::'C fl"iVfl II:DA"II"II 981Bflfl_i... ISA"II"CN "II"IFiIIE Ci IAUIi Cli::i.111'S D iC ELSE If::If5IINA'TiQJN IIP 11 ESS Ti IIAN A YEAR.
Signature of City Clerk or designee
DaAt"w
Office Use Oniy
Approved application
DCI report
State certified driving record
..................
Website update
Cledu7AXIDRNBADGEAPPL92074.,nentled.DOC 02/2015
Inquiry Date:
2/27/2015
DL/ID #:
428XX5832 (IA)
Customer #:
222610
DOT
Abo Elhassan, Muna Magribl
Class:
D
ID Status:
None
Mand
Address:
2532 BARTELT RD APT 1C
Audit #:
8522366
DL Status:
VAL
%
Issue Date:
n ..
• l� A ILII,.
None
City/State:
IOWA CITY, IA 522462720
Expiration Date:
JN6 y MA NOf Ok
CDL Cert Status:
None
Oftrre of PrYWerr1�+4r�:w' ***
Endorsements:
3
CDL Ned Status:
yy�{yy�� Pk
PG Doi, I Dee Vmres l , 5030'3-€.e
Mailing Address:
2532 BARTELT RD APT IC
Phm-& E15-244-9124
I8OC FaW 'o!Z1 Fax 515-2ZS-lE3I'
Restriction
None
Inquiry Date:
2/27/2015
DL/ID #:
428XX5832 (IA)
Customer #:
222610
Name:
Abo Elhassan, Muna Magribl
Class:
D
ID Status:
None
Mand
Address:
2532 BARTELT RD APT 1C
Audit #:
8522366
DL Status:
VAL
Issue Date:
10/10/2014
CDL Status:
None
City/State:
IOWA CITY, IA 522462720
Expiration Date:
01/01/2019
CDL Cert Status:
None
Endorsements:
3
CDL Ned Status:
None
Mailing Address:
2532 BARTELT RD APT IC
Restrictions:
NONE
Restriction
None
Date of Birth:
1/1/1974
Supplement:
Mailing City/State:
IOWA CITY, IA 522462720
Sex:
F
� Ott
Name: Abo Elhassan, Muna Magribl Mand DL/ID: 428XX5832
Pursuant to Iowa Code §321.10, 1, 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 sealof the Department to be set upon this document, at Ankeny, Iowa this date:
�'"� '•��
•�
2/27/2015
"�
IOWA
).O. -T
1�YEY
Office of Driver Services
�
Iowa Department of Transport
Name: Abo Elhassan, Muna Magrlbi Mand DL/ID: 428XX5832
ation
Mar. 2. 2015 4:12PM Div of Criminal Investigation
I .' .. G 1. G V 1) 11 I J n III V I l) V 1 0 1 M1 b I l y U I 1 U V d V I L y
No. 1480 P. 2/6
No. 5001 r. L
To: Iowa blvislon of Criminal hivostli(atlon
Support Oporatioas Bureau, V Floor
215 E. 7'^ Street
Des Mollie#, Iowa 60319
(51� 725-6066
515)725-6080 Pax
M-om: CiifcyofVawaCStt+
City C➢olrlea Oft e,
4.10 I„ Won!hE a $an Streek
.._tawa_C�t .k A "622486
Phone, 319;356-5041
...
Fax: 319-356-5497
(nclulo.uly)
As of.._I._�- � � � a search of the provided name and date of bitth revealed;
No rows Criminal History Record found with Ddl
Iowa CriminalIdistoryRecord attachcd, U#
DCll initial$, E �
hrt-77 /nsMc 101
Received Time Fe6.2 .'2015 11:09AM No: 1846