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Home My WebLink About14-191CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 a 9) 356-5497 FAX First 1. Dame — ( c e an ry 2. Mailing Authorization Nu ber_L -.� �jj j (Office use Only) (Police Department review must be made Monday IMiddle 3. 'Telephone: lomie.._.._c,cy_:_ Tither: 4. Prior experience in transportation of passengers: ___ Last 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Tvoe of offenseWhere When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five C,:) years? 7. Have you been convicted of any traffic offenses in the last lave years? When .............. 8. Has your driv&s license or chauffeurs license been suspended or revoked in the last five years? Type of offense --- — Where 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)j�7 You must apply for an Individual Department of Criminal Investigation Report (form available upon request). • • • r 3#= dwW�Mubado 03/2014 I hereby certify that 1 have issued to me by the Iowa Department of Transportation a valid Chauffeu s license number 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) Signature of Applicant '®=� Date_" - ' �- [ C r 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 r r On this day of vvr ay S. Notary Publi n and for the to of Iowa 1 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). Sig re of I Chi 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. SignatOreof City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be ii'/2" (width) and 5'/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update 03/2014 c1erkfl"Wvbadgeapp2014.d0C Aug.12. 2014 2:32PM Div of Criminal Investigation omiuullou Aug. / . LU 14 J : IV rM ' City WerX - UILY 0 Iowa Lily mu oli amium us STATE OF IOWA Criminal History Recqd Check 10 RequestjForm Tor Iowa DIVIdah of CrImInal Invelfightlan Support Operations Burma, 1" Floor 3111M 7" Street Dev Mines, laws 10319 (615) W 6066 (,414) 7254090 Pax NNo'�I7160 P. It1/1 o, v I Y 64.7'ei/f/ DCI Account Notinbov; (hr CRY Cork's office b., Iton Mireat .. ... ..... . ....... .. .. ... Muci 319-3q6-9041 . .......... ........................... Iaaa 319-356-3497 al am regu6sting an Towfl. 1tacwd Check oiv ................... ... . . ............................................................................................. . ....................... — .................................... a ('mmdawnj Mrit'NAM6 WiniSgiory) Middle 'raw6 (Trravitm�mdrd) ...... ............. . ....................................................................... ....... . ............................................................................................ . .................... C ............. ....... . . .............................. . ......................................... . ................. ......................... —.1 .. .................. Date of Birth rwiwidwwry) G'Mder (Mandgfow) Security Number � onmegr1p.4� .................. . . . ............................ __....Social ... ............ V71 L ............ .............................. . ..... =-.- . ...................... . . ... ........................ Wgullowit a'Agned waiver fu Ow suh�cct of th6 request, a coin evirrifikal Inkfory recopil may not �, ]d er bere,geasable, per Vodaoflawo# CbapterC92,1 �Forg� arlinninalldsilory record 14(ormuflon, as aglow by �avp$ shvikyg obu �n a we Osul) Ut Ouha re no ............ .................. . .................... .. . ............................ WffbeY AeleflSe: I hereby give perai for the above roituos ong ofildol to ooriduct en law& onailaul h6lory record chochvith the DI vIS Ion a rNminiol - Tomfigadon(DCO. My candnal hIs(ory d4(a conazi me 1h.a(b m&ln(alood by the DCf maybe refused Bs allowed by law. ......... . . ....... ....................................................... . ............................................... L�I .M............M..............a...... i !ERecord C.eek .Realts (DCJ use only As of... 11!--i .................... a seatch of the provided name and date of birth revealed: L No Iowa Ckimilial Hiskq Record found with W1 Iowa Criminal 14istory Record auaehed, I)CI .................. .................................. Received TfmW'A'u`ga17." 02' 2014 3:19PM No.6603 U W W co l I ml , 011 n r ISI � IIIb � iurltui �� i� � IIIUII I I u l OffilrDINyk*ef OPUttrtd, I"TIDOVV'I'lallflWO-5,32, 1 Q 1 ill.. P)II/11t11Crp,?fl?4,II�110%gJPolbSAW,13,JNn~k,Luf&i�ll.� 102f]4 515-244-024 AXPa$Rh239%8f/ Names Seedahrned, Zoelrigar Khalil IDH.1111: 684A37191 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, is have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: ,.Rtrr1ry. 8/26/2014 m„ r MIA uaF mm' II" uuu oMmT „pim rcm .•m"'. mmm il. A ummN � Off'vre of Driver Services Iowa Department of Tr ansporatlon Certified Abstract t1F Driving Ili Inquiry Date: 8/26/2014 DL/ID #: 684A]7191 (IA) Customer #: 6082387 Name: Seedahmed, Class: D ID Status: None Zoelfigar Khalil Address: 2656 ROBERTS RD Audit #: 7286386 DL Status: VAL APT IC Issue (Date: 08/28/2013 CDL Status: None City/State„ IOWA CITY, IA Expiration Doom 0:1/22/2018 CDL Cert Status: None 522462'742 Endorsements: 2 CDL Med Status: None Mailing Address: 2656 ROBERTS RD Restrictions: NONE Restriction None APT 1C Supplement: Date of Birth: 1/22/1968 Mailing IOWA CITY, IA Sex: M City/State: 522462742 History IMfformation Names Seedahrned, Zoelrigar Khalil IDH.1111: 684A37191 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, is have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: ,.Rtrr1ry. 8/26/2014 m„ r MIA uaF mm' II" uuu oMmT „pim rcm .•m"'. mmm il. A ummN � Off'vre of Driver Services Iowa Department of Tr ansporatlon