HomeMy WebLinkAbout14-1041. Name
Authorization Number f — f 6
�
° (Office Use Only)
J 0 i
Department
between 8 a.m. to 3 p.m., Monday — Friday.)
No
2. Mall¢"ngAddr, ss..a.:...�G '2-C .4 ;x (a'd / `a ... 114 ate
.............................._.............................................................
3. Telephone: Home ` 0 _..
tJther:........ / ..........................I.....�.'�:"...........`.
4. If o xgsealenco elmtrxnsl®orkstionofpasseolgers: Ge.p € Airy. c4bo l—
s
............ ......... ....... ......................... —
5. Have you ever been convicted of any misdemeanors and/or felonies in flroi!s State, or elsewhere? dv 0
IMM
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?
When
When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last, five years? ,. IVO
Where
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
A% 0
daxntddmsdp 032014
. hereb �� a issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
� certify that I have
I � -� :"` '-'zr -! . 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
�"� Date
YOU ARE NOT VALID TO DRIVE A TAX! 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 ) ilk
r
Sub nbed d sWom o before me byOn this
' t �=Ssa'n I Yl B9 "� s�.��� �-- rte. ? day of
4/
rye
i11�,,,m�ar2z1�>s�tg Notary ublic in and for the State of Iowa
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).
or designee
1 1°____________ ---
Date
YOU ARE I46T 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.
Signaturd,of City Clerk or designee
Aa1.1
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 51/2"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
clerkbAdr1vbadgeapp2014.dcc 0312014
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Certified Abstract of Dirl,whing Record
Inquiry Date:
4/18/2014
DLI Or
799AK5578(IA)
Name:
Ahmed, Hassan Mohamed
chosen
D
Elamin
Address:
2510 BARTELT RD APT 2C
Audit IN
7995578
Issue Date:
04/18/2014
city/ tea
IOWA CITY, TA 522462716
Expiration
61/18/2022
During
Endorsements:
2
Mailing Addro
2510 BARTELT RD APT 2C
Restiniddown
NONE
Dat® of Birth:
1/18/1978
Phillips City/States IOWA CITY, TA 522462716
Sam
M
History Information
NX �, 11 A
Pursuant to Iowa Code §321,610, 1, KI&Snook Director of Office of Driver S
Customer 62.1351.4
AD SI I
IRK. staturn VAL.
CDL, Staitann None
CD11. Cart lischain None
COL Med Safitain None
Restriction None
supplementIN
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:
Marian Ahmed, Hassan Mohamed Elannin BI 799AK5578
4/1812014
01
X
ar
Office of Driver services
Iowa Department of Transportation
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I 11111111111111111111 111 111 Is IIIIIIIIIII iiijillillill'i�,,:Iilili:�Ill'I IIIR�111 RipI111111111111111 111111111: �I iiiiiiiiiiiiiiiiiiii
Apr,22. 2014 2:06PM Div of Criminal Investigation No. 8 17 1 P. 1/1
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Iowa 0111 ek dd =40
Phone: 39.9-J96-9041
Nam .. 319.3g6-94,97
.Middle Name (rMunaun ndod)
....................................... ._
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No Iowa Criminal Mstoq Record found -with DCXILI
Iom Cc'pminai HiFfory ll cord attaoheai,, .DCT #................. _....._
.... :.
C'wN
Rlceived Time Apr, 18, 2014 3763PMo0795