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Home My WebLink About14-242I A t t .••'III t CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 3S6-5040 (319) 3S6 -S497 FAX 1. Name (REQUIRED) 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.) 299 to con Yete ttro "°ro aaarerf gra/caa gt on vraf9 result in derr/a9 o/ t/ae.a/ttt/rog((gg First a 3 f 1 2. Mailing Address (REQUIRED) 0 3. Contact Information (REQUIRED) Email: Middle - c ( (dA -' Last .�. ( o e -C S WE 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Where A 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs Ih'the last five years?_ A/0 �r Tvpe of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? O Type of offense Where When 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? Type of offense W�- When W 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provide the name(s) A) 0 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) 09/2014 I hereby certi th t I have issued to me by the Iowa Department of Transpertatiorl a Vai'id Chauffeurs iicense number rd (� Y`f �It3 . I understand that if I falsely answer a+ly qu,:stions in this application, that This application may be denied. I understand that if I falsely answer any of the questions in thls 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, lova, in their discretion, to examine any and ail records and documents relating to this application, and 1 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. (W so.z to bc- a!gnsd in',?mnt Of a tN3clairy i715k.17ft) yy p Signature of Applicant Date__ i ✓ �f I YOU ARE NO VALID TO DRIVE A TAXI IN IOVVA CITY UNTIL AUTHORIZATION IS RECEIVED FROM'fHE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. STATE OF IOWA ) COUNTY OF JOHNSON ) Su cribed and sworn to before me by Pd '_\.ra9m. ac, On thisday of ........................................................ _.................� ___1 . a I have reviewed this application, DC1 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). Sig7t re of a Chie or designee /6 -27 -PI 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. Signat Te of City Clerk or designee' 111--, Z --'/Z Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %11(width) and 5 %1' (height) and prominently displayed to all passengers. v✓i Approved appltcailon � DCI report e State rtified O'ltling re Cb'rd Website update Office Use Only . 6,-,,XIDRt\'0ADGEAPPL92014 mendeC.DCC 09/2014 Aug.29. 2014 4:22PM Div of Criminal Investigation No.8313 [P. 1/1 Mug. L J• L V I `t I V• J 7 h 1V I V I l Y b I C I N b I l Y u I l u W d V I l f Id u. 7 I L 1 I° L I I � DCA AocouBrntNumbeha �Ov" tG¢mwwRloabls� To! Yawn bivicloh of Criminal Y®cvestlgalloh 1Frwuh Cfttt of ltnvva Cp Support Oporatlony Bureau, V Floor OW Cleflei Office 215 B. Inn Street 2610 , �YaalxilnOtoh i�tr®s c Deg Nxotneg, Yowa 50319 (515)1x5.6066 Y®vra Cdth U 52260 (516) 7256080 gar Phones 3.19456-500 P"a�c 319-459.356 3697 if aas re uostirr. aau Jf®ova CBlrnlnak Ydawltta ecvss°d Cl�ool oBna Last Name Cnrsndasa I � 00 artue (naWndflwy) Ndd[eNAhAOOMAm=dO a,. Data of /�Sucia9 SeeumriR N rsalyek' 000mlmmdw (0 �� G ',l alas �1Ed3ruala 337 "S"119 e0 alper zftfbps^ ddon. Ithm a sftg»aod Waiver from thio gsyblect of t'h,a r quoat, a oouappote celmlold paftstorlr roeos sl may not be r®leagals9o, per Cer1a oYYo ad Chapter 65202.1 For a erm Vnal h2stor,y recsarst lssrormoigoann ns aploaved by Nave, npwAya obtwNou a mvaftvara neturafroB>r Lhoaa¢a ect oStftoregHg¢^ _.._..� Walyer. jemye.°aheeeW�ygtvogorn*SlonforeftWbnVesorpftffegOffiO NW eandornMlawaerAWAVAhllwrrrsoordnhrekwith slnoYy1*10PworrOnAnd Yrew kYgutYen(Bo p) Ary WbA[W Molaayrdale Oonoa¢aaBorogns0what laMal law., �allnsuRA"u�"��Vs6aYalx'vB.. . ALHUffyR u. As of �� " , a searob aofthe .lor avrt a end date of birth revealed: 00 No :hr a Orhaffial .Hhfory Record found vwiffi J)f"7C C: i lova Cndrraaraal. &fistaory:lKer ord attached, D C1 �® . DCC ianatlalq Rp�s 1155 T�af la 11 o.'1F.�0?Q 14 10-3AAM No. 71194 Iowa t of Trans Ipo rtike M 10 Sam Img„tries urge&, A'A 02114,, o1 7,24 M24 OW FAX 615,2M CLEAR D111:111WING RECORD Name: Hagelamin, Tawfig All Elsiddig DL/ID: 713YY6890 (Pursuant to Iowa Code 9321.10, 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: Nairnen Hagelamin, 'Tawflg All Elsiddig Di./IIIX 7:1.3YY6890 8/21/2014 w I Office of Driver Services Iowa Department of Transporation Certified Abstract of I)rIviling fRecolyd inquiry Date% 8/21/2014 DL/ID #: 713YY6890(IA) Customer ; 2068875 Name: Hagelamin, Tawflg Class, D 11D statulm None All Elsiddig Address: 811 HUGHES ST Audit #% 6119105 DI.. Status: VAL Issue Date: 07/12/2012 CDL Status, None City/State: CORALVILLE, IA Expiration Date: 07/16/2017 CDL Cert Status: None 522412143 Endorsements: 3 CDL Med Status: None Mailing Address: 811 HUGHES ST Restrictions: NONE Restriction. seme None IDate of Dirthg 7/16/1980 Mailing CORALVILLE, IA Sex: M City/State: 522412143 History information CLEAR D111:111WING RECORD Name: Hagelamin, Tawfig All Elsiddig DL/ID: 713YY6890 (Pursuant to Iowa Code 9321.10, 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: Nairnen Hagelamin, 'Tawflg All Elsiddig Di./IIIX 7:1.3YY6890 8/21/2014 w I Office of Driver Services Iowa Department of Transporation