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Home My WebLink About14-228Authorization Number —L — 1 1 `, (Office Use nly) CITY OF IOWA CITY APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) 410 East Washington Street Iowa City. lovza 52240-1826 ra!e9r rea '¢af_a��ffu 9c g� w"rwar &_a9a�:a. °w drifas,rr�'a_aaffon will resin in deniaa9a�fifl'(r�_�a�t�� tw•a�sr� (319)356-SO40 (319) 356-5497 FAX First r Iddle Last., t. Name (REQUIRED) 2. Mailing Address (REQUIRED) I��O�e Aoti�(V9 3. Contact Information (REQUI[RED) Email: /j�� i"Mwto Cell Phone: CjffL2 �-- �a 7 5,. 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? _ Aj PJ Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? e,.I` 0 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? JV 0 Type of offense Where 11a 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the names) 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) I hereby cailif,, that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number � �"s✓ _' _ I understand that if I falsely answer any questions in this application, that this application may be denied. 1 unde. tand that if I falsely answer any of the questions in this application, that this application will be denied. b 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. (Needs to be signed in front of a Notary Public) Signature of Applicant Date 1 U YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UN Y'IL 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 Vjt•Qk � f'cOo jAg—tA, . On this ) `') 0A day of .— t, I .. — A— a u I 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). a Slanature dIT/bilbefflgeor designee lel, 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 lcgov.crg. ,xi.,1 8igna tre of City Clerk or designee ` Date Taxi cab businesses are required to provide Driver dentif.'scation cards. Cards must be 8 %1' (width) and 5'h" (height) and prominently displayed to ail passengers. Office Use Only Approved application DCI report State certified driving record Website update Cla WrAXIDRNHADGEAPPL92014am ded.DOC 09/2014 lr� �rrDOT f(��L JI CUSTOMER '� ° $ ;» r r . ecu., t h SMARTER I fflcp010dwenarrlrAl7les ro Hew 9704 � f Mas ll aillrvWS, IlA 'll" I,PSa =4 )°VuAi w aaMfl-244, Q1,641'dkl@{lw612.)12W II Fay, vnww!!Hul:.iinwwwadot:glov Inquiry Date; t0/A412014 DL/1D N; 274AD4829 (IA) Customer &; 5437579 Nomme Abdoarahman, Yasir Hashim chasm D 10 statum None Addave ; 1409 PLUM ST Audit #: 7399196 Ed. Statuae VAL own I'ip121tlA4 _ ifM9174A Mlp4 Issue Date; 10/02/2013 CDL Stasis; None chat . IOWA CITY, IA 522402121 l spiratlon Durso 07/05/2018 CDL Cart States. None l ndursemem os :3 COL Mad Smasom None Moiling Address: 1409 PLUM ST Restrictions, Corrective Lenses Restriction None Date of Mirtbr 7/5/1961 supplement; Nothing CRY/. km: IOWA CIN„ YA 52.2402.12.:1 sww:� M elm cwttabtrwwu IDate w'o nnrhaella n EmTo ACID ILocllalla nnUOI R County Lit Vrra2Jl rA*Al, ��woai �u�,wwd reulm4w,1.. ,I,A vau/nceA::a�n�ii _. ;'..��v�raiav�lalas uArrtr.alr�ll��u�+lu�,��wwep _ p __....... _... _...._.. _ ,:eea�uvu;auro ._ ruw, own I'ip121tlA4 _ ifM9174A Mlp4 _ ._ !wmnld!!ry llnr„r II`mpgllstvsurthnlm _ �arolnruukMun .. i11A JAW'Pe"CA2e:14 108,1.61221I4 ;S92 ;'ipead AohiRyll!n f1A Aa.Wl charµ 00W Cum IAWII!wllllwer :HJR II.A/70172"2 ',lnw47v •iTA Name: Abdelrahman, Yasir Hashim DL/ID: 274AD4829 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 sold office, and that I hove been authorized by the Director of the Iowa Department of Transportation to so certify. In witness whereof, I have caused my signature and the soil of the Department to be set upon this document, at Ankeny, Iowa this date: a A0/Y.4A2Q414 s Office of Driver Services Iowa Department of Transportation Name; Abdelrahman, Yasir Hashim DL/ID; 274AD4829 j��ulf�ll iill Awg. 29. 2014 4:19PM ulll Ifi IIIII� IIIIIIIf Div of Criminal Investigationy STATE OF IOWA �i I�r '"wT f'`,; i w 1 gat 1^ 1No. 8312 lP. 1/1 I.auukrcgIlflC:!alM- attn�CownCriu�lxnal:l'lf t covdQ,'laeo%4bDno' ............ I,sa^Y't.1�au�sefraradaerx Ilfnvat:lNaraf.ur...l�n,ra.�...... �a�1f�I�Ialaa{eearxvrcnaa� ...... .................................................................. : to noewall eeead. 'Number lreaasnanxinarcsdw ...1 , ? a ��&.1� (uuw vm�?�u) ..................................................... Gender grdnmrl ......... ..... NqP M ale Eirraernaae �'� .,,,. °7 .- .. —.1 ........................... __...............................................f.......................N...................... avtt gel Na �frefstta w wimoutt asp nein svl6lvemoea l➢aosubject of"th re GdlCtt a mono- kiL crdumffnM luotforr mecavd uaYay. not he releasalhla, per Coalo offowa, Chapter 6912,,'or �o8map10Raf ealevafnal history 6eccord Information,as agfowrd by Ia% ralvq+,aya oMfprrnavwafvcrslSra tlgrr.(Ma�.l .. de_4tlW!L0tfb�tlueMM�elruoaft......................................._.... �9'PY"^S".�.P?PR?aNu�`C?^ k.rwaaagey e6�itn permnll�xslaYb.OnH'00Yn iwjwaWa En�,etc.eYPrrp� et7aa8f6f Y0k WplWafvdY, F, ett G®WSA ¢v�$eYWeAeC IladxkarpVear.,atfsl uaanr.Yc'uvtiCRu flNdm A�d0.�pk4�ora erk•'��Kum,14aY&f I6nwcsatgAkYew¢ IDC& Alftyenseafni Ws racy data eanwmoor; nm tat Ila rnMncOwd by I'dam A�;"C r9M1RYIp�e, Beltabre;l w 6&I�stW� d by pmv.. ®m6wu o- CSraaafsra a: n. ....................._.._.... ............................ ................................................................. _.......................................................... ....................................................................... ......alown .. . :...m1111al :la:t61.n I.�� ........... .... (nclweset» asparch f the .. As ofl............. ............................... 0.8. ocprovitkd nun, and date oflt1ch n°ee'�waiell„ NoIowa, Ca;Bmzr-iaf.:(-.lttatoV.Ikecoa'd:fo vvaf'h:X.'1 �......� Iowa erhainal HistoryRecoid sttaciceda I)t,I'ft............_..................................................... C, a I': cl.T'nuftial,. " .................. ........................................... _..__.................................................................................................... ... .................... .... Received TimerAug.25..02014 12:16PM No. 8342 o F Q l A�.u:e sntlunt YKPArdC&": 6(appnffrca6CO To, Iowa Division of CrlminalIuvwHgaHon From- tPltr aQlmuva iffy SupportOperatloniRureau,VITfoor Cu:¢pCferlesOffice, , 2x5 716 Street y dI0 'a pxfrr fops Street .... Des Molnef, Iowa 90919 (515) 729.6066 JnLk Ci p WA 92240 (515) 725.6080 VAX ]"lnonet -350_5U61 ..w21.9 Fax: I.auukrcgIlflC:!alM- attn�CownCriu�lxnal:l'lf t covdQ,'laeo%4bDno' ............ I,sa^Y't.1�au�sefraradaerx Ilfnvat:lNaraf.ur...l�n,ra.�...... �a�1f�I�Ialaa{eearxvrcnaa� ...... .................................................................. : to noewall eeead. 'Number lreaasnanxinarcsdw ...1 , ? a ��&.1� (uuw vm�?�u) ..................................................... Gender grdnmrl ......... ..... NqP M ale Eirraernaae �'� .,,,. °7 .- .. —.1 ........................... __...............................................f.......................N...................... avtt gel Na �frefstta w wimoutt asp nein svl6lvemoea l➢aosubject of"th re GdlCtt a mono- kiL crdumffnM luotforr mecavd uaYay. not he releasalhla, per Coalo offowa, Chapter 6912,,'or �o8map10Raf ealevafnal history 6eccord Information,as agfowrd by Ia% ralvq+,aya oMfprrnavwafvcrslSra tlgrr.(Ma�.l .. de_4tlW!L0tfb�tlueMM�elruoaft......................................._.... �9'PY"^S".�.P?PR?aNu�`C?^ k.rwaaagey e6�itn permnll�xslaYb.OnH'00Yn iwjwaWa En�,etc.eYPrrp� et7aa8f6f Y0k WplWafvdY, F, ett G®WSA ¢v�$eYWeAeC IladxkarpVear.,atfsl uaanr.Yc'uvtiCRu flNdm A�d0.�pk4�ora erk•'��Kum,14aY&f I6nwcsatgAkYew¢ IDC& Alftyenseafni Ws racy data eanwmoor; nm tat Ila rnMncOwd by I'dam A�;"C r9M1RYIp�e, Beltabre;l w 6&I�stW� d by pmv.. ®m6wu o- CSraaafsra a: n. ....................._.._.... ............................ ................................................................. _.......................................................... ....................................................................... ......alown .. . :...m1111al :la:t61.n I.�� ........... .... (nclweset» asparch f the .. As ofl............. ............................... 0.8. ocprovitkd nun, and date oflt1ch n°ee'�waiell„ NoIowa, Ca;Bmzr-iaf.:(-.lttatoV.Ikecoa'd:fo vvaf'h:X.'1 �......� Iowa erhainal HistoryRecoid sttaciceda I)t,I'ft............_..................................................... C, a I': cl.T'nuftial,. " .................. ........................................... _..__.................................................................................................... ... .................... .... Received TimerAug.25..02014 12:16PM No. 8342