HomeMy WebLinkAbout14-1211. Name
2. Mailing Address__
3. Telephone: Home
4. Prior experience In transportation of passenger,:
Authorization Number
(Office Use Only)
Department review must be made
betweenrMonday
Tr -
Other:
VM
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
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6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?
7. Have you been convicted of any traffic offenses in the last five years?
Impe Bei ryh(r.imo-w Where
S. Has your driver's license or chauffeurs license been suspended or revoked in the last five years?
rel
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9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
0
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
a wady 03/2014
I hereby certify that i have issued to me by the Iowa Department of Trans o ation a valid Chauffeurs !lcense number
;> P. t. C_, p d✓k 9 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
cf a Notary Public)
Signature of Applicant 'A Date O;LIA�
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 )
and sworn to before me by 1.5o� , u . 0sLk "'' On this ,✓ 4 $�a day of
".."'A s'A
Irirf�ATi?
I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter-
mined that there is no infoimation which would indicate alai the issuance woWd be detrimental to the safety, health
or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code).
Sig u o„ lice 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 lcgov.org.
Signature of City Clerk or designee
ate
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and 5'/:"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
dwkflm1dr1vbadgwppM14.d 03/2014
hMay.27, 2014 3:02PM
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e
• 6
CDiv of CrimnalInvestigation
Tot Iowa Division of Criminal Inveat1gathan
SupportOperaiione Bureau,1".toor
.219 R, 71b Street_....�.................................
Dewe Moinw, Iowa 30319
(515) 725.6066
(515)'725-6080 Fax
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From„ ,,,,�%A,�y urf:lowrva City
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Iowa Ofyx KA 53240
Phone; 319-3.516-504f
Paz 319,-3.04497
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iodal.
dhod,i sifned wa Wer fu°orrn thorsu bject of the reuynelutd a compaloto crpuuaircuralpsu,aWry neord naay no@:
WddVeP itelease, Iberebyevo pormisslon for 1ho abo9orequeslleegoffiotai to emrdua an laws atminel hlsroryrewrd chock with IhoDlvitlon of Criminal
lmestigasion(DO). Any criminalhbloeydat®wnumhlgmethatiilnalnlalnulbythoDC1MkyborotoareGeaallowedbylaw.
mot"faaiv 8 wsaafrarea Afl yi (.)M(X)JAeA
SOW C�°'��l:��l til° raa:urt Check Results
t�tmi� ��K lel
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'„ ra< saai°�lr oI`tlxo)tii�owrtaC.adraatxv.ta aD.d tl�atrs o�'latuflt t�cvealeSA
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No Iowa Criminal MsioryRecordfoundxdthDCI
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Iowa Odhi i.al History Record allrac eat„ DCI #........................... _ r
i1R'",N a (1 Psellw
ceived Iufne May, 20,, 2014 4:55 h".9231...........
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F'alian. s'1.1 -244 9124 � 803 M.4121 121 R.ILau 515.2:M-1837
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Certified Abstract of lDriving IlRecard
Inquiry paths
5/20/2014
Dt,/ID iRo 239CC6458 (IA)
Customers
1640461
Names
Omer, Naiwa EI Awad
Class: D
ID Status:
None
Address°
322 DOUGLASS C6
Audit Ss 7992065
DL. Status:
VAL
issue Dated 04/17/2014
CDL, Statutes
VAL
Cllty/ states
IOWA CITY, IA
Expiration 01/19/2022
COL. Cart
Excepted Intrastate
522465402
Daths
Status:
Endorsements- 3
COL. Had
None
Status:
Mailing Addresw
322 DOUGLASS Cr
Restrictions. Co Instruction
canon
ructio/7/2014n
mitercial
RResstpric
ts
EDP res 14emit
Date of Birth. 1/19/1969
mauling City/Statak
IOWA CITY, M
sax: 3
522465402
History InfOrrolltiOn
ConWCtICIMS
0tation Date
Cunvvil1lon DatPl
ACD 3xpf n kion
...
f'mr1. a.Nflt f .. .Id3iR,
07/02/1.010
0'3/03®2Qhf0
i1Rn4 No Insurxloce Card
.,,. N, ,,....,,.,
' ohn.�raeY. IA
,w.,,........
.m o. an x,rvrev
.n'Y C'Y 18APY 117
i.3s'R LHPtG^4.i'ltlVa Ughts
?.IIX5l7.YY'dbl'I IIA
Accidents - Accident inv alverreuent indicated does 140'r imean the iirndi"sv ilduai was at faui9t or given a cha"On„
f�cuw'i�buwaimin Du3n:U,�ue"r
3UR
I Kim Snook, Director of OffiCe.of Driver Services, Iowa Department of Transportation,
1,, 1
an
rd currently in the custody
Transportationr � to 50
certify -
In witness whereof, I have caused my signature } the seal of the Departmentupon thisY: I
this date:
¢ ®^® 5/20/2014