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Home My WebLink About14-169Authorization Number /— ® 1 (Office Use Only) t a"alll �® CITY OF IOWA CITY APPLICATION FOR TAXIIMOTo ED 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 ya� (319) 356-5040 (319) 356-5497 FAX First�"' Middle (Last � 1. Name . -- - r------------------- 1_c G_ - -- - � L ' 2. IMailing Address.,Z5 3. Telephone: Home. � z'�___________----- Other: 4. Prior experience in transportation of passengers: .________________________________________________�— _. 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? if WIMEWRIM Cdr 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? AZ nMq of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? -Al 14 (13f1" ` + r When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? At 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) 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) dwkrmaJNvbadg 0312014 V hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number ^eU fi; �Lfo I understand that if I falsely answer any questions in this application, that this applicati n 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) g ., f �p �L Signature of Applicant w �f 4 q -R' l" g � Date f .-- I rj 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. STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by (: e On this _ p-&,,.� day 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). q 1-1// � Signature 7TD a ordesignee Date YOU ARE 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. Sigau e of City Clerk or designee G g, / /. Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and 5 %11 (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update dwxr�md1,w adg�-W14.d= 03/2014 It -Aug. 14. 2014 4:02PM °;D v of Cr.m'nal Investigation, fNo.1424 - P. 1/1 u° Illp+llllll uu Ill�lmo DCI Account Number; ti@ag�p6Coabfrl To! rowa Dfvlslon of Criminal Tnvestlgatlon From :..... gjl z-of71O!W,P Chy Support Operations Bureaus 1"Floor CU), C'°len°lc°s office 215PD. TbStreet 31A1'JFr.'wa,rlxfivagt -'strep, Doe Moines, Yavra 5037.9 _....._• (51 s) �z5e _. _ .. 1Caarra45ad0.. . ....._„ .......... (SIS) 725-6080 Vaac _ _ Phone"';sa,9,3R1S6- it ............................ Fara .....310-3%4091 �—�e-s�eH u puxrsfn ars lova t:AIMIN41 C� istoay' iteic6rd t hemkow II�� F'aal R't 1avuIrlle, Cxw11,1Aau0iry) ..cyst lt�a1!'n.J; 6auumno em 67 pe...le q prl G,,f,.,—., V n ......... � C, "�z IT"e lyas^ rif Y°nualopar wahoul ¢i odjgned s 2fver from tlnorWgact of Rlwe n m.� ts¢, a a:anngrvpkte mtnIlnla) nimtL a rd may not be rOiUsable, per CoAa ak Asvas C:laaptor QR;42„7„ �aar5l rrmpldgt� elt°lanllmap lnlstmre° arae' l imNtty raatlm a ae a¶toy eat pap pear, ap saps _-_111 . . A.. . _„ , ,...., WalverRelease; Ihereby @l a ermsslonfor the xbovere aealhsoffeialrocondactanloaacriminalhslonlrezwrdtheckWilh[be DIVIslanofCrim lda[ lnvosultntion (ACO. Any erlminal history data conmmingme Ibat is mainlalncd by the ACC rosy be released as allowed by law. werivel°S'igrealu're”;..................... e, ... , ....w__.. ai ux••�••1 ..� ....................................................m---.... ... (ACl use only) As eb1, " a search of the provided name and date of birth revcaltd: ; Y '''' l�'o lows C:r€tnual ]fdistot .p.eool°d found ®vith I7�g . • r, , Iowa Criminal Ilismi:y Record attached, int „U .......................... v,. .......... ..� ew'zi'tneu a„rd:,,,ar^,IIP,'::,.111,.G(20Ib1:i6k!l No. N11 9 D0'1"r Ini./ID Na "^�'ww�w/wM✓✓r� II11 6260655 pp��pyp@ Y¢'"� yppp�p;�pp ��dwe d a.Y Noureldidn, Gaffar Hamid All � y; AARTER q nklf��iP j� �gww qq^^ g @@ q #Uov III �W4k�'�' MMU IPME, �� av nwtol+'m nm w uua m+u w:xaar ED Statuou None Addinesuz 4`�'•IV`�fld':df AYIi Yaly'�'",�mSm'r/�6Ats Audit S! 8345407 DL Status: KJ FkYA��'u 4M' 161m�M�0IMokl,wt;�u, IK A a�itl&`"G M 9211M Issue Det®: Rimper, 515244 CDL Statue: None CAfflilBdan!l eia>wama-knilmsaoirtzk; M v Ceiliihiied Abstwact lot IDui viDN Record Inquiry Dates 8/12/2014 Ini./ID Na 834AK5407 (NAI customer as 6260655 Nama: Noureldidn, Gaffar Hamid All Cip"IN: IYA ED Statuou None Addinesuz 2534 HARTELT RD APT IC Audit S! 8345407 DL Status: VAL Issue Det®: 08/12/2014 CDL Statue: None CAfflilBdan!l IOWA CITY, IA 522462721 Expiration Date! 01/01/2021 COR. Cert staftea None Endorsam aden 3 COL Med Starting None MaDtnD Addreaa. 2534 HAKMLT RD APT 1C Nestricterun NONE Restriction None Date of Dirtfn 1/1/1858 Supplement: Malang City/Statsin; IOWA CITY, IA 52.2462721. iiilan:u n 4!NtlIMAIrAM 00A UAit711kMM10110 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 accrete 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 se 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: ®®fi�gt A,e 8/12/2014 f0! qq I On T, nw.w iPiS�am�fwww wt5d W. Office of Driver Services Iowa Department of'Promportation Narver Noureldein, Gaffer Humid All DL/ID! 834AK5407