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Home My WebLink About14-155410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX Authorization Number (Office se Oniy) Department betweento MondayI. IFirst Middle 1. Name .__________— 9`L_ ______________----------- ek u 2. Mailing Address. -1 o q--_- _jv c 3. 'Telephone: IHlome._IA Other:, 4. Prior experience In transportation of passenger's: ,_______________ ILast N 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? rof offense 1 6. Have you begin convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? II e oP„C7hYe;1.. ----------- -- 7. Have you been convicted of any traffic offenses in the last five years? va , RM ________________________________----------._.._....______________ __------_-_._.._____ ____________....._________, 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five year, ? ---- -----,____ 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) You must apply for an individual Department of Criminal Investigation Report (form available upon request). (OVER FOR REQUIRED SIGNATURE AND NOTARY) nig 0312014 �d I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 0 1 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) r flfl Signature of Applicant Date �• " Y 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 On this L9 n 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). Sign aty a of Poliye hief 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. M1 I Wki wri- =-�- Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and 5'/2" (height) and prominently displayed to all passengers. Office Use Only Approved appl'cation DCI report State certified driving record Website update de*ft;ddnvba0geapp2014.doc 03/2014 fl 1� D uu�u uu� 315AE6704 (IA) P�pp##��qk tpgqppq�g vAM1@p9PUIT p�py DMq p +�.kY<%T�,✓rr E 9b�V ' vaimmorm. .mer umw�mm nnnwaom a:�.ww offirI't:a4 of 14ISprvx s Name: Elawad, 1I Sayed Class: D ID Status: None Phone°nl'Fs'..0r4-*41;2411:l1I'M 11 F= 51S -?:i13.48,9 701 ARCH ROCK RD Audit #: 7809345 w^PbW'4..itwodol Certified Abstract of Driving Recihlrt) Inquiry Date: 8/5/2014 DL/ID #: 315AE6704 (IA) Customer : 5460751 Name: Elawad, 1I Sayed Class: D ID Status: None Address: 701 ARCH ROCK RD Audit #: 7809345 DL Status: VAL Issue Date: 02/20/2014 CDL Status: None City/State: IOWA CITY, IA Expiration 01/02/2019 CDIL Cert None 522452700 Date: Status: Endorsements: 3 CIDL Ned None Status: Mailing Address: 701 ARCH ROCK RD Restrictions, NONE Restriction None Date of Birth: 1/2/1969 Supplemenill Mailing City/Stat®. IOWA CITY, IA Saw M 522452700 ration Dzte 0.onvktl.ion Date ACID rn=piauiak tls»:: County Jul,", I7y./j._22..00..1.1.Il . ...,._...._...,.„,11. ,. 1592._Speed...'Aohlins n 0/10(201 X9_ ro:e:__d... lahmssa .. ;IA ... 0c0idt::vt IlDate M/31/200,0 w a .,,+ h m y� F baa. w «. ■ Transportation to so certify. 111 1111111 111 11 111 111, 1 '111111 I'll 111 11 117111 Il' '!I "I I i Il' 8/5/2014 nl-T Jul. 31. 2014 4:20PM ID,v of Crim nal Investigation, iii m1 _ . _ ... _ _ . lti� NI mi iim STATE O)F 10�� Vy i)�4f3h�1 4•yCriminal History Request Forin n NNo. 6167 pP. _1/1 o4n r a aues6.'u............:..:...:........................."..:....: in�ai iIu tceal r Record Check ow ra aaq Coda (agnrq Last„ ame...611u....m&cegn;AD......................._ whstfiTaal%aAnNk4Mdasryy) ................................................. AUddleNow6(geccmllaOul* ...........................................................................................................................................................,.........................��.... _................ .............. Date oflik! rt/naood4tmny) e'nder(mum�;dall)......................._..................................................8001alSeottmd 'l�tmiabes^'t�ee�nl�asllaa� ......................... 0�' .ale MF6remale _ �....... ....... cErntGge 1XIDleEtofthoselnaasl„a_..".,, ................ ................................_.............................,,,.,. r _ .....................dlboflo'wa Chapter auinn, geloarclq:gdrualhhtor c'eeou°mluforrlmodolnlasallovq^dby:Ilawlalwayar. leo ,eleaselule, pep° t o sa: flhou 'na OpeatWaiver tn: torn Me oro n nmol hlston ataec'r,frs tsa°r�attdtl 1 le s ' � al 7tny kawra always aa5tmlla i4 walvel^ Algrnl),plr In"aaaln flqug suph eot.......lea..u::5.11au rlA........................................ .,. ' Waiver Raldare11 hereby$lve perminnion for iho above requcedng oMdal to conduct an Iowa erimhW hlttary record ch6tk with the Division ofcrie,inal lovoBllsatlon(Dq. Any dleI 111I doom 001100n11og m41141 Is AIa0A.4y4IIa)Xlan raleaeed as allowed by law, Waiver Signature; (DC! use only) As of ................................ .... _...... ......� "1 L ............_,e a search of the provided name and date of birth revealed: No Iowa Criminal History Record found with DCI :. �,m,....� Iowa Criminal History Record attached, IDU Rt D(.2 inilial ........... nrT -77 MOK P 0-, Received Time Jul.30. •2014 2:52PM No -5957 DCI AccountNunI 400,) fl' (irapplteabl®) To: Iowa Mvision or COMInal Investigation ITMou t':fitY. 4.q] nvana Y)y SupportOperations Bureau, J." Floor a¢;yc:;1',ls°A0."AKD 215 F. 7`a Street 410 A '(V'gt,Ahg ?.10 u Street ....................... DesMolnes,Iown 50319 (515) 725.6066 laws B." y, TA 52740 .................................................................._.............................................................................................._ (515)725-6050 Fax Phone: :81,9M356.56i 11 Fax: 31.9 M6,5497 o4n r a aues6.'u............:..:...:........................."..:....: in�ai iIu tceal r Record Check ow ra aaq Coda (agnrq Last„ ame...611u....m&cegn;AD......................._ whstfiTaal%aAnNk4Mdasryy) ................................................. AUddleNow6(geccmllaOul* ...........................................................................................................................................................,.........................��.... _................ .............. Date oflik! rt/naood4tmny) e'nder(mum�;dall)......................._..................................................8001alSeottmd 'l�tmiabes^'t�ee�nl�asllaa� ......................... 0�' .ale MF6remale _ �....... ....... cErntGge 1XIDleEtofthoselnaasl„a_..".,, ................ ................................_.............................,,,.,. r _ .....................dlboflo'wa Chapter auinn, geloarclq:gdrualhhtor c'eeou°mluforrlmodolnlasallovq^dby:Ilawlalwayar. leo ,eleaselule, pep° t o sa: flhou 'na OpeatWaiver tn: torn Me oro n nmol hlston ataec'r,frs tsa°r�attdtl 1 le s ' � al 7tny kawra always aa5tmlla i4 walvel^ Algrnl),plr In"aaaln flqug suph eot.......lea..u::5.11au rlA........................................ .,. ' Waiver Raldare11 hereby$lve perminnion for iho above requcedng oMdal to conduct an Iowa erimhW hlttary record ch6tk with the Division ofcrie,inal lovoBllsatlon(Dq. Any dleI 111I doom 001100n11og m41141 Is AIa0A.4y4IIa)Xlan raleaeed as allowed by law, Waiver Signature; (DC! use only) As of ................................ .... _...... ......� "1 L ............_,e a search of the provided name and date of birth revealed: No Iowa Criminal History Record found with DCI :. �,m,....� Iowa Criminal History Record attached, IDU Rt D(.2 inilial ........... nrT -77 MOK P 0-, Received Time Jul.30. •2014 2:52PM No -5957