HomeMy WebLinkAbout14-194Authorization fe
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(Police Department review must be I;
between 8 a.m. to 3 p.m., Monday — Friday.)
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6. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /itf 0
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Where
am
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? A) 0
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense
Where
When
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8. Has your driver's license or chauffeur's license been suspended or irevcllred in the last five years? p
Where
When
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
deddaAdMadq 0312014
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I heretiy certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
E`:X' Avir _Ie m"i'fQ . 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. (Needs to be signed in front
of a Notary Public) I',
I
Signature ofApplicant ', Date—_ .1
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 )
scribed an sw rn to before me by u fi h m On this day of
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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 It ify of Iowa City (Title 5,'Chapter 2, City Code).
c�
ignature of Police Chief or desi 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.
Signature of City Clerk or designee
D e
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and 5 W
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
.1wkRawdIWaC9M00201.4.C:- 03/2014
Ileo i _... C igah on
Aug. 22. 2014 12:22PM Div of Criminal Invest
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Crelminal II :hex I"rctrd (Check
Request f i fl ; c'..
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Criminal
Streetsupport OPOW10112 Bureau, 1"Ploor
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hag Moinag, YOWA 80319
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Iowa Criudnalffisto Record CheckResufts
As of _ "" ° a search of the provided name and date of birth revealed;
No Totaoa Criminal l ilisfory Record forund with DCA.,
Iowa Criminal History Record attached, DCI #
l�CI lnldials
Received TimeTAug. 19. [Q014 3:57PM No, 7458
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Cisiti irad Abstract of IDrivitig limo d
Inquiry Date:
8/19/2014
DL/ID
346AE4411(IA)
Name:
Hamza, Elkheir
Class:
D
Restriction
Mohamed Awad
supplement:
TA
Address:
2401. BART ELT RD APT
Audit Or
4442025
;hp hvr:ron
2D
Issue lluteu
06/17/2010
Clty/state:
IOWA CITY, IA
Expiration
10/02/2014
522462701
Date:
Endolrsementm
3
Mailing Add s:
2401 BARTELT RD APT
Restrictions:
NONE
2D
Date of B :
10/2/1970
Mailing City/stats: IOWA CITY, IA
Sam
M
522462701
DL statue: VAL
CD4, statues: None
CDR. Cert
None
status:
ExpaIaUon
CDL Med
None
statue:
X, 01 X4/'009
Restriction
None
supplement:
TA
w'iW:ian Dap
:J:oni':::tui n IJI&LM1:
ACD
ExpaIaUon
cci a::u13'
„,11JIR,
Ili/:P 5120179
X, 01 X4/'009
S92
Speed
:J::hare::'I
TA
09f2IX/201fl3
X,0p"08,,(20I&'3
I1:04
Seat l:6eft A1a:IWlan
;hp hvr:ron
II1A
Names Hamza, Blkheir Mohamed Awad DL/ID: 346AE4411
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 seal of the Department to be set upon this document, at Ankeny, Iowa
this date:
a;
UNA
Office of Driver ServicesIowa
Department of Transportation
a;