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Home My WebLink About14-183Authorization Number _lq— �° g (Office Use Only) t III w® 1 1 �¢ 9 CIN OF IOWA CIN APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made 410 East Washington Street between 8 a.m. to 3 p.m., Monday — Friday.) Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX �y� First Middle Last 1. Name „. 2. IMailing Address,_ ------------ 3. Telephone: Home.Other: _ — — — 4. (Prior experience in transportation of passengers:.___p j LL ............. ...... ............. ........................ _................. ........ . .................................................................................................. . _...... ............ _. _.......................... . ...... _.. _. _.................... _. . ................................ 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? ISV Ipa of offense 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? "0 7 Have you been convicted of any traffic offenses in the last five years? rrl M M & 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? t-' 07 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) 6V 0 ........................... .................................................................................................................................................................................................................................................................................................. _....... _............................................ ....__.._..................................................................... • N w • $I A .0 You must apply for an individual Department of Criminal Investigation Report (form available upon request). (OVER FOR REQUIRED SIGNATURE AND NOTARY) CWddtaMdr1Vbfflg 03/2014 p here,pe tht 4 h ave issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 0y l lu . 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 Ash Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERICS 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 � ,�_y_LjgL____________. On this .(rr _, day of n w X m .. ...tt * A A r r wrier s. rrtk rp=ia! i Notary Public in at)d for the State of 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). Signatu o Polic " ief or designee Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERICS OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. Sign re of City Clerk or designee ............................... .... .. ..:-............................................ Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/x' (width) and 51/z" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update derkft x1d ivbadgeapp2014.doc 03/2014 Inquiry IDataa 8/9/201.4 Maimaee Klr)a, Kamil Hassan Address:: 2401 HIGHWAY 6 E AFT 1606 lltyjstate� IOWA CITY, IA 522406709 Name: Kirja, Kamll Hassan DL/ID: 809AK8656 Certified Abstract of IDrIlAing IRecard DL/ID: DOT1°� Clasm D Audit M 8098656 Issue Date: UARTURn51IMPLER!CESSi(EM"' Expiration Date: NIUE.E .1... 2 Restrictions: NONE 01ft off E"low 1/1/1975 Serra M F0 I[AM 'Mv I"MOS MICA 105, III1I'k'47i1MG-IP"MI A"tnawaar*^' uwI":w- r»^tt mlia°fl ('a111R1F'^m't9.D 121 k i"Saar' lait'o- (2"4T1 IrI137 wwv«1a'WAw y&TA.q&0 Inquiry IDataa 8/9/201.4 Maimaee Klr)a, Kamil Hassan Address:: 2401 HIGHWAY 6 E AFT 1606 lltyjstate� IOWA CITY, IA 522406709 Name: Kirja, Kamll Hassan DL/ID: 809AK8656 Certified Abstract of IDrIlAing IRecard DL/ID: 809AK8656 (]A) Clasm D Audit M 8098656 Issue Date: 05/23/2014 Expiration Date: 01/01/2019 Endorseentr: 2 Restrictions: NONE Date of Birth: 1/1/1975 Serra M CLEAR DRIVIING RECORD customer a 6227659 ID Status: None DL Stature VAL CDL Status: None CDL Cert Status: None CDL Med Stator: None Restriction None Suppiemsnte 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, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: Marne Kirja, Kamll Hassan DL/IDe 809AKS656 8/9/2014 Office of Driver Services Iowa Department of Transportation Marne Kirja, Kamll Hassan DL/IDe 809AKS656 /Aug 21 2014 11:36AM //'Div of Criminal Investigation YnF, w"LSTATE O IOWA 1 Crimin rp� "I I1� irl J Check Request F ,`, To, Iowa Division otCriminallnvestfgatfon Support Operallons Bureau, L"Floor 215 E. 714 Street Des Moines, Iowa 50310 (515)725.6066 (515) 725-6010 Fax NNoa7984 pP.`1/1 DClAccount Number: ��(Ml - Firm., CkVofbwaa truly aty 4"lcrlaros office 41.9 5, Was,sfndwwuyfen latraet I6wa CI6.y, IA 52241 Phone; 3131166.2061 Fax: 3.1.9 "196,9497 Iont,ar, r2rDINIa�n:Lehrl/a(lir',Bsnhml3lietoa�ll.eooead2lteok�po, �...._............_.........., -......:........:-"......................" 2 Hilt Naalne (mamdepe�ru Middle ddle fi~lHU.1e (fecwaxnau I..o�t i[Snafl:aue ianem6in mdi.dj ................................................................................................................................................................ ..�, ................................................................................................................................................... Date. of l"l1 rtl1 cminainmary) elndel anemilapcu,gp aa�tl��- p�nar,x ' z t ��°...G..r ��(� ��........... K.:::; q yd°aax' YCrb3 'MP' 1(daav l Wullout it vlgaueai walva p" (a'aappp, the alalu,jed of the rcq umt, n c:o6q)1oie cylkninal blwl.obry re6oYr6 a my not tinerelae,suWs' Pee Code, ofIowa,(.'haluter6923.1NovAa,Wl9r,t Orlin Not lalstovyrecord lln(ormat:fon, asagiowgdbylow, always olataatn a a alw er„al6proae nra lrourn 1.Rnaa„gnngpReat: ctflue rr pest. ..... �........... .............. ....... ...... ..:..... WaIMR21814S&,Ihereby givepemissionfor the above, requesting o(ficfaltoconductanIowa etinllnelhistoryrecordchock wMthe DI slonofCriminal Invanigatlon(DCII, Any criminal history data conumfngme that is maintained by din DCl may bo roleasod at allowed by law, a” 114Ipnaa.aaswar ..................... LA" ........................................................................................................................................ .,................� �l r �, .r ;m ...1� �......... .. ................. (VkCI!nui�e�pOngy� : �g ui'1 As of . ” r ....... ....a a. se cln eftl a provided ln.am.a and ad ale of birth. a°evealed: Ido Iowa Calzrihial History Record found with DCI Iowa CYIlnlnal Histoxy Record attacked, DCI # .......................................................................... DU i1'alliaisl r., .- ACI -77 (08/25110 Received Time Aug. 14. 014 9:41AM No.7030