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CITY OF IOWA CITY
410 East Washington Street
Iowa City, lova 52240-1826
(319) 356-5040
(319) 356-5497 FAX
1. Name (RE("AUl RED)
Authorization Number
(Office use Only)
APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.)
wgc(fwftf ¢f of ff(f (ewr e `"c �ffn(e f ¢ "" information will Pew»ult in denial of (GpVwT tf�wp (ctg
2. Mailing Address (ISE Qt9BR D)
3. Contact Information (R Y UIRE:,GD) Email: -2S4121
Cellphone(;,,)"g-.
6. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?
. a_
M
7. Have you been convicted of any traffic offenses in the last five years?
jype of offense Where
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
Type of offense
Where
f1i
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 CEBT7FIF
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEFRE'
You must apply for an Individual Department of Criminal Investigation Report (form avallable ypop,request).y
da
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
092014
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
0pfd V "sd . _ 1 understand that if I falsely answer any questions in this application, that this
m
application ay 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 'he City of !owa City, Iowa, in
their discretion, to examine any and all records and documents relating to this application, and ! 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 itie: l : to tte evvg •acw in frcnt
Signature of Applicant """ Date__(u 1, t
ll
YOU ARE NOTVALID TO DRIVE_ A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED t=ROnfl 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. l g 4- ii lAA -4.. d On this q day of
=tea a_ ss C[•a wP� �q
in and for the State
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).
N,„µ.
Signature oli 6 -Chief or designee
ate
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.
Signature of City Clerk or designee
D to
Taxicab businesses are required to provsds Driver identification cards. Cerds must "°de 8 %" (width) and 51/2"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
c1erWrAXIDRVBMGWPL92014e WKW.Doc 0812014
J/1
1/23/2015
DOT
24BAD4337 (IA)
Customer #s
5409180
Namas
Ahmed, All Omer All
class
D
ID Statues
� lov
Address
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g (USUNpEFky � %�
.
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DL Stature
VAL
iofifa.e of Driver "Senti ms
Issue Dates
10/01/2013
CDL Statues
IPO Box <k204 a [Nm IPd arm: tin 'A,2306 -92,D4
city/state:
IOWA CITY, SA
f'stie .: 5 15fM4,6124
� 13:00 632-11211 Fac 51!TZi9 T07
CDL Cert
None
wvAv..loarvd<roh.gyry
Certified Abstract of Driving Record
Inquiry Dated
1/23/2015
DL/ID #n
24BAD4337 (IA)
Customer #s
5409180
Namas
Ahmed, All Omer All
class
D
ID Statues
None
Address
2401 BARTELT RD APT
Audit #s
7392384
DL Stature
VAL
IA
Issue Dates
10/01/2013
CDL Statues
None
city/state:
IOWA CITY, SA
Expiration
09/22/2018
CDL Cert
None
522462701
Dated
stature
Endorsementrs 3
CDL Med
None
Statues
Mailing Address:
RD BOX 2532
Restrictions.
NONE
Restriction
None
Date of Sirft
9/22/1968
Supplements
Mtalllling City/States
IOWA CITY, IA
sam
M
522442532
W @9vtlrd;maio!Date C011Wt;W;P11ft 11419ic)
09/IIP 1/2042 P1/0812012
Name: Ahmed, All Omer All DL/ID: 24BAD4337
a
Transportation to so certify.
History Information
AOf.& E:,rlfll0nnwtla:lrc�wry T1omm4vt:y .3W11'C
T ,II itll to Obey y Deffilr Sligni/rSi011r,r1 Johnson 114N
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:
W1'" 1/23/2015 ,
D D T, e'
11 `...."� r Office of Driver Services
Iowa Department of Transportation
Name: Ahmed, All Omer All DL/IDs 248AD4337
Jan, 20. 2015- 4:06PM Div of Crim nal Investigation No. 8380 P. 1
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(915) 725-6066
(61S)725-6020Fax
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Time—Jan. 15.-201'x••••. 4�•24PPll--No. 80.3 .....................
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