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Home My WebLink About15-031A 1 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 346-5497 FAX 1. Name (REQUiRED) 2. Mailing Address (REC Authorization Number _j pA I�_ (Office Use Only) APPLICATION FOR TAXI / MOTORIZED PEDICAR VEHICLE DRIVER (Police Department review must be made between a a.m, to 3 p.m., Monday - Friday.) Fri/9trre to c2-IMI-0es� flue "`aetrauererd ' auaforrnafion will resulit in denial of thahapRtd�ata�rn 3. Contact Information (REQUIRED) Email: Q I l hQ n66 a (-CAell Phone: "25 6 --B*A -9114 4. Prior experience in transportation of passengers: eveS 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? I= 6. Have you e n convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Where 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When B. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense 9. Have c� you ever applied to be an Iowa j City C 6 1&14 o 1 _`6 c� Where driver using a different n When If yes, please provide the name(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CER**IED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF INVIEW, You must apply for an individual Department of Criminal Investigation Report form availab le upon request). (OVER FOR REQUIRED SIGNATURE AND NOTARY) 09/2014 10 rtify that 1 have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number %�f �2) . 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. (tNeads to be signsd a frcnt of a Notary Public) Signature of Applicant""mom " � 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. STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by E=LL . � r�®) r(i a 1 C"a . it r� o rav On this "7"rl:..tr. day of K,. t, I , , a w.,,,... 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). Sign ure ` ° e 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. Signatureof City Clerk or designee ate Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/d' (width) and 5'/%' (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update ClazldrA%ID,3NMOGEAPPL82014e ded.DOC 09/2014 Yl 04 t N�9 r .�i #CUSTOMERJ wadotg v .,�ui*n,,, . SMA rIII wOf0 to -d Drij'e�t'.Drvu mr II 10 it ax! 11291 S ¢ EMA41Mnes, IA'�'0(4YkQa42i W 0.1iAom: 515 244 - *U4 WO 512 112"G II RA' 51,wra7,39 18:37 Inquiry Date� 2./14/2015 Address:: 2401 BARTELT RD APT 2C City/State: IOWA CITY, IA 5224621 Mailing Address: 2401 s Mailing City/State: IOWA CITY, IA 522462701 Certiiffied Abstract of ICDiriviiing (Record DL/ID : 422AF7170 (IA) Class: D Audit : 8788773 Issue Date. 01/23/2015 Expiration Date: 05/13/2020 Endorsements: 2 Restrictions: NONE Date of Birth: 5/13/1960 Sax: M HistoryInformation Customer M 5609235 IDStatus: None DL Status: VAL CDL Status: None CDL Cart Status: None CDL Med Status: None Restriction None Supplement: Accidents ..,Accident Ilnvolltuement indicated does INOT mean the individual was at fault or given a citation. aAeddeni Date Case W'3ionireer .R99R Q'U6,$A.23;6� 3 ;144204.. ... ,. IJ A Name: Ibrahim, Saifaldin Omarab DL/ID: 422AF7170 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: Ibrahim, Salfaldln Omarab DL/ID: 422AF7170 2/14/2015 1 ♦ J Office �of DveIowa Department at rransportaflon Name: Ibrahim, Salfaldln Omarab DL/ID: 422AF7170 °°I Feb. 9. 2015-10:40AM Div of Criminal Investigation III I G V r IIII IIII IIIIIIIII V• LVO I• J V I A b I% y V, 1 0 1 a b i l y U1 1 U W d b I l y isSTATE OF IOWA Criminal i, , .I� rw o r Check Toi rowaDivislon of r r A rI 11,; r 'ro 219Z 7'h Street Des Moiner, Iowa 50319 (915) 726-6066 8 . awe �lb"i�a �:N"iBtldYIpA7 No; 9889 P; I ]DCi AwattNlertSSoR4kboA"s Yid .m� (9gep�NrNdrsBaYe� _____. From; fBEALvwACIV_______—_________. City Clark's Offto �d6 d oeks& nStreeff___________. Xmsva �`!& a29� Phone;1[,�•�•50dA Val., 11FOMR10 J\ -- 6 gaSv g alS"�aavR�dSaaaaA fRfwotut� Ia6 uneoff awagver from the subject of the mqueat a eommplote ordm inaff gafstory record tunny nnaot be o°alessi0 e, per Cade ®ffIowa, Cllaogutw 691.'2. FornmWp1q crkuraguwA Wary record ganforaeagfonp nm ashoav'ed bylaw. always MaN a w0vos°,slmMuar^eff'rom ttbo,Wubfed of the recanut,. WdalverBelan+ e.,,n`yJt@Qoy �,�V6�„'d1Aai9ai6Po mewMe doya NCQ,U6Ons offs d eU eoiduc59W Iowa rllft66 A gldhkoiy vuorid Phack with oho Ma'am ofCaY1Ffut snrrsuhp UonQ)CD., Any erMmaummBNewry dadm xamimamrettlnevVamalolai&4tl yfiwACYragberderxsrAwWBerwe bykey, l rims 9.� u �u . tm" . (Dcrm6ee rye �s as ,_------ S ____, a watch of the tarrvvt c8 sn it and dabo of birtlu g°��raIl�d rA No lm C&nlnal M t ry'Rccor d So' d With DCT Kowa. 01minaf kfistesry Rzcord aftaohod, DU # CHffltlala _. Received dime Teb `"tM'015 1:48PM No. 9834