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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319Q!�-j504
(319) 356-'Y497 FAX
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1. Name
2. Mailing
3. 'Telephone: Home
4. Prior experience in transportation of passengers:
Authorization Number N'lF,.
(Office Use Only)
Department reviewbetween 8 a.m. . 3 p.m., Monday
Middy Last
_ Other.
V40 C. JAI
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? _---IAJ Q
When
6. Have you begg convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?�
Type of Offense Where When
7 Have you been convicted of any traffic offenses in the last five years? 6
WMI
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
4
Type of offense
9. Have you
rr ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
W15
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
mdddnadg 03/2014
MA
i h b certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur'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 w)th all of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public) G
Signature of Applicant'" Date_C "' ➢
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 Lt s *,k eD i n y Yr -k k i On this _j a 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).
Signat a Pol' e ief 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.
Signa ure of City Clerk or designee
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/:" (width) and 5'/z'
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
der,Aw dr'vbadjmpo2CL4.dcc 03/2014
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Aug.,12.
2014 2:23PM
Div
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Received. Time,(Aug._ 6.,,,2014 4:1.3PM No. 6519
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1FNI Box /Xr�ritM I BBs W16i Ines, IA raCUWO 97.(71
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I'Ortlifilim:d Abstract of IDiNvIflwg Record
Inquiry Date;
8/6/2014
DL/ID #s
832AK7321 CIA)
Names
Yousif, Mohieldin
Classy
D
Restriction
Seedahmed
Supplements
Address,
2.502 BARTELT RD Al:q
Audit Ns
8327321
IC
Issue (Dolan
08/06/2014
City/State°
IOWA CITY, IA
Expiration
01/01/2019
522462713
Date:
Endorsements. 2
Mailing Address.,
2502 BARTELT RD APT
Restrictlamn
NONE
IC
(Date of Ifirtlin
1/1/1958
Mailing City/States IOWA CITY, IA
Sem
M
522462713
History Information
CLEAR IDRIVIII46 1IIECORD
Name: Yousif, Mohleldin Seedahmed DL/IDs 832AK7321
Customer a 6258178
ID Statauss None
IDL Statue: VAL
CDL Stature None
CIDL Cert
None
Status.
CIpL Mod
None
Status
Restriction
None
Supplements
Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department at 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 seat of the Department to be set upon this document, at Ankeny, Iowa
this date:
8/6/709:4
0. T :•
° •°" ° .P' Office of Driver Services
Iowa Department of Transportation
Names Yousif, Mohie[dln Seedahmed DL/IDs 832AK7321