HomeMy WebLinkAbout14-190410 East Washington Street
Iowa City, low 2240-IR26
(3 1 9356-5040
(314) 356-5497 FAX
First
1. Name
2. Mailing Address_
3. Telephone: Home
' Authorization Number J ~ ,
1 ( j / (Office Use Only)
b Papaw
2- W l e e fs81 4
Department review must be made
between 8 a.m. to 3 p.m., Monday — .,
4. Prior experience in transportation of passengers: t K t t
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? N' 6
1
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? 'f6
7. Have you been convicted of any traffic offenses in the last five years? .__.____
MM
RM
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five, yrimrs?
r
When
9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provide the name(s)
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
dadd�ddnvbadg 03/2014
I hereby certify that 8 have issued to me by the 'owa Department of Transportation a valid Chauffeur's license number
pry. . I understand that if I falsely answer any questions in this application, that this
application may be deni 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 ny and all records and documents relating to this application, and I further agree that, if a license
is granted, to comply at all ti as 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 " 4 ("L Ll 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.
STATE OF IOWA )
COUNTY OF JOHNSON )
e me by . a his �' day of
Su cubed and sworn ) I ��
!I � .�� before fi .. �... —CLE
22 1819
Notary Pubo inandfor the State ofIowa... r,ipwdrovnls,,,rnumb
., Wu x . f�ilYtlilWl1LZps
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).
y /))
Sig ure olice Chief 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.
....................r '7 ._ .._
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width) and 5'/2"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
Ce1WUAdmbadgeepp2014.dcc 03/2014
mawwwowdidiI�DOT
I91
IPC) BOX 9764 ; Des IMclux l4 K 50 306 3"a2A4
i'TwF,,: 515 2.444124 d BOU ':a3:2 11 s I ( l w. 515 239-1837 "
waur.lsaw:adcrE.cyo ,
Celrllified AIIlEf rBDt of Bruning Record
Inquiry Onto:
8/26/2014
DL/ID #:
214CC9840 (IA)
Customer #:
4313828
Name:
Abdelmzig, Abdel
Claes:
D
ID Staters.
None
Rahman Mohamed
Addiresm
2442 WHISPERING
Audit #:
7576761
DL Stature
VAL
MEADOW DR
Isaue Datoa
12/03/2013
CDL Statuar
None
Cutty/States„
IOWA CITY, IA
Expiration
01/01/2015
CDL Cart
None
522406005
Date:
stature
Endorsementm 3
CIDL Med
None
Stature
Mailing Addrown
2442 WHISPERING
Restrictions;
NONE
Restriction
None
MEADOW DR
Date of Birth.
1/1/1956
SuPPlement:
Mailing City/State: IOWA CITY, IA
Sax:
M
522406805
I;MT�nlzmr.T 11=1
cWA;radon i:'axate Conw9nW; ou !!Ibnte
12,12,V2031 O1/01/201.2 ':592
x wWent Date
Name: Abdelrazlg, Abdel Rahman Mohamed DI ID: 214CC9840
mm
! .. lI
l'. • } :
In witness whereof, II have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this
date:
8/26/2014
w
D. T.n.
d
Office of Driver Services
Iowa Department of Transportation
lumuuo Aug. 26, 2014 4:20PM
MI n u 6, L I Q AV 17 1 4 1 1 ptl
IME
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in Mill
Div of Criminal Investigation
Vitt V,cIn V11r V, avna vitt'
STATE OF IOWA
'4
Criminal Hr o tilt oh kil Check
k
Request -( 1 o '
Tot Iowa Division of Crltninal hit
Support ®poi°ationa preap, V Moor
215 E. 7m' Street
bes Wines, Iowa 50310
(615} U5.6066
(ISM 725-6080 FAX
1No, 8125 fP. 41 A.
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M aaf........._ ' " � t � ..._..� n sm-ch offlic prorvlalcd unem o and data of bIxh'1'i :izvealed
,. No Iowa Cu:uaarulonal liflatoq Xteord 1"0uAd with JDC1
1C1T,Ii,11IS.,
Received Time7"Aug.21.'IC2014 1:26PM No, 7610