HomeMy WebLinkAbout14-0789 � II � ._
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--
CITY
--
I F IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
2. Mailing Address
3. `telephone: Home
4. Prior experience in transportation of passengers:
0
Authorization Number t ®1
JO WC&-Vl (Office Use Only)
IIIIM
6. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
1
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? A/ 7
n2g of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?
Where
8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years?
I
When
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
01V oilr •l J� I 9-00YAll, I Fy-o U U 14 LVYA I LON I aqj• .+ 1:4ZIt1
da VhWdrhbsdg 0312013
I hereby 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 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 Applicants y ,�.� / P✓bP r Date "' -20
STATE OF IOWA )
COUNTY OF JOHNSON )
bi scribed and sworn to before me by ���t
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� �� �
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y Public in and fot the
On this 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).
Signa e of Ptc hief or designee
,- Qlel
____C.1afe ____
YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY
CLERICS OFFICE. Authorized taxi driver names are placed on the city website at icgov.org.
Sign e f City Clerk or designee
Date
Taxi cab businesses are required to provide Driver Identification cards. Canis must be 81/2" (width) and 51/2"
(height) and prominently displayed to all passengers.
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Office Use Only
Approved application
DCI report
State certified driving record
Website update
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Div of Criminal Investigation
Oily ui err - Uity of Iowa Oily
uSTATE OF IOWA
Pf
Crinlinal-History Recokd
Check
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To., Iowa Division of Criminal Investigation
Supokk Operatlons Bureau, r' Floor
218 E.7i° Street
Dee Moines, Iowa 50319
(515) 725-6066
(cls) 729-6080 Ax
No. 5719 P. 1/1
No. 4515 r, t
DC1 Account Number: 4-tw), -F
From, .....Cl.........i y of Pa �a CiR
City Clerklw O to
410'F.Woslninglon ltraaR
Iwo CzkY..krk $2240
Most 31.9-ia64u00
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Waiva.r^,l°yr... ,� .
_. rrr�rraliehuw k�°llpaouu& a �wi nnstt wai'vor t%°orn kine subject enrkbo request, � eonn lore a
� It i n eS n� p t a y not
be r°oieasatalo, per Code ef,Yowo, ChApkear 6911 For �gglppgplp erin wheal histo roesrar6 infortnawn, mt allowyed by low, alwqs
obtaafil awvataver aw' naRaurofr' ra.tiworaa0 ori,„yaS,Ptak„ieaiwlla :...._...................
Waiver Rei¢ase: I bar -by &a permission for rhe above requating oftel to eondncl an Iowa criminal ldraoryreeerd check with the Wdslon orcAminal
Invenigalion(DO). Any crImbal Wilory ack conecoilag me Mil Is m4fMaind by [be )DC1 may he Mused u allowed by law.
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As of....,,....13,,� ,��°"' � .... a search of the provided name and date of birth revealed;
No Iowa 6,fi inal.'lllakory Record round warath DCK
Iovn, Criminal llh.,t nry ld.eeord attaaiw.ad, DCX #,........ .....�
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Received Timel",Mar, 20. 02014 3:09PM No.5644
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Convictions
Abstract of orr vins Record
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379AE8597 (IA)
Customer as
5558422
inquiry Datan
3{27/20x4
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SD di@atss:
None
"Arra ibtt Yullsd,".. .. .,
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AhmedEmail EI Dlne Baim'1
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Names
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D3/19{2614
cart carr
Col. CaaVl;mfnNusan
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IOWA CIN, IA 522461714
Expiration
66/26/2022
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City/ice°
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Endorsememtsa
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Restriction
None
Restrictions;
NONE
soppiamentr
Mailing Address:
PO BOX 2044
Dare of Bial
6/26/1974
MaiBn® City{Bream'
IOWA CITY, IA 522442044
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Convictions
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Nome: Ahmed, Emad EI Dine Balm 011 379AE8597
hereb
hat
am the
st
Y, Kim Snook, Director of Office of Driver Services, Iowa Do' rd currently
of Tri nthe CUtlon, of said affrce, and
dttthat I have been sIn
Pursuant to Iowa Code §321.10, that this Is s true and accurate copy of an official remrd wrren0y in the wsmdy
records held by the Office of Driver Services, that
to so certify.
the Director of the Iowa Department of Teamsp
in wines, 'her f, I have caused my signator* and the sial of the pepartrnant to be set upon this document, at Ankeny. dews this date:
°e r �PzaTa.6x4
IOWA",.)
)° , T.
offlor. of Ornoat Sarvlaes
Iowa Deportmant of Tranmpartmtiae
Name: Ahmed, Emad EI Dine Balm DL/ED: 379AE8597