HomeMy WebLinkAbout14-074I r i
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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 5 2240-1 82 6
(319) 356-5040
(319) 356-5497 FAX
p� First
1. Name , _ p C ,A �r
2. (Mailing !address
Authorization Number I
(Office Use Only)
60 1
CAL
Department
between 8 a.m. to 3 ,Monday
3. 'Telephone: Home 11)2112,_�j 1"
4. (Prior experience in transportation of passengers:
ME
9M
; 2-rz
IL.ast
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? _,_,_P ? �?
I
N=
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?PV o
7. Have you been convicted of any traffic offenses in the hast five years? ,____6
When
When
B. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? At 0
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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)
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You must apply for an individual Department of Criminal Investigation Report (form available upon request).
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
nvbada 03/2014
he Iowa
of
I here ce ify I) at l av ssued to me b t I understand that f Ifalselyaansweaa n a valid Chauffeurs license number
�a y Department p 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 a6d 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 the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public)
Signature of Applicanf"" Date ^" L
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 ) / e; kvri `
COUNTY OF JOHNSON ) t„r C
Torn
y C Nnt this � t ' day of
� b ai... �. z<_r O
red d s orn to before � k� f Z �t
ore me
dn/
1 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).
Signature olice h f or signee
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.
Signatu
of City Clerk or designee
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/d' (width) and.5 %”
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
tladdtm1ddWedgespp2014coo 0312014
Mar,18. 2014 9:05AM Div of Criminal Investigation
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STATEDF
CriminsYI ✓ r History
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l i;
queft Form'
wa Division
Support Operations Bureau,loon
215 x I,, Sireat
Des Haines, low 50319
06
(515) 729-6080 Fnx
tNo.5367 PP. L5/5
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1DCIAccountNumber: LI4® 9�~
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From: Cad$ aE.11owvo CK@y
city cleA°k n office
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Y owVaa Clu. XA 52246
Phone: M•, 16.6041
From 315M6^`6k~<s4Q'f
Lown 4.ArAItIfA11141, XmtoR JASICUU111 WIA4CU K. 1Kg nID
(DOuse only)
Aj of, u a aearch of tha provided name and date of birth revealed:
No Iowa (yladoal I3istaq Rceor'd f'oaiA with DC°I
c.+
d>� Towvax earflm in at IfistotyRecord atti shed, DCC
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DCI -77 (005/10)
Received Time Mar. 14. 2014 9:02AM No.5103
i
Milli % 1'110""'im/i/i/i'f
,
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SMARTER I , I L. ST°"All DRIVE -NI � o�m���ammmoo�am�
of Virwar Soi
iRO Bux2041 Des Wkmnae . I 50306-XV.4
Phwte: 515-244.,91241 II -532,1121 I rax: 515-2a-1811
IWC 4
1
Inquiry Date:
3/25/2014
DL/ID #:
6791
Customer #:
6073198
Name:
Sharif, Ayman Mahmoud
Class:
B
IDStatus:
None
Mohamed
Address:
1901 GRYN DR
Audit #:
7062538
DL Status:
VAL
Issue Date:
06/22/2013
CDL Status:
VAL
City/State:
IOWA CITY, IA 522464408
Expiration Data: 09/18/2018
CDIL Cort Statum
Excepted Intrastate
Endorsements:
PS
CDL Mod Statum
None
Mailing Address:
PO BOX 1555
Restrictions:
NONE
Restriction
None
Date of Birth:
9/18/1967
Supplement'
Mailing City/State:
IOWA CITY, IA 522441555
Sex:
M
History Information
Convictions
Cita Il:Hcinu Date
co nvilctlll1lln Illtcllle
,4t.111l;11 I cpiainatilon
Com iltvy Juit
Ili vnu„l'^i a
09/,o,",l20d.',3
SC)Ili °,lincestd
tl4ullki�SWa '..,iA
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Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of 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.
;. ""•.:�0 3/25/2014
D. 0.T
Office of Driver Services
°1e66 Iowa Department of Transportation