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Home My WebLink About14-054Authorization (Office '-,! f j U, 1. Name 3. Telephone: Homy ? Chi �- L 1 ' Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere �_ . When V ........... .................................... .................. .....f ......... .......... ..� _............. 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? A [-U 7, Have you been convicted of any traffic offenses in the last five years? RIM 6. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? , _______ -Eype of offense 9. Have VOU MM d.,Wb.II 03!2013 U hereby certify that I have i§sued to me by the Iowa Department of Transportation a valid Chauffeur's license number bC Llr /� Zi�f�.h . 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 wi:l 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 tt"t+�a,° ti-��-�'��`� �"�C""\•. Date a STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me On this _ day of ®_ n s ®J 001151fly-WR fPWT 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 of Police Chief or designee � 0X �a stet 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. 4 PRIEM , 12 0 Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/z" (width) and 5'/d' (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update dere0m1drabsdgaepp201o.doc 03/2013 6'aj� U'V SMARTER I SIPAPUFR I CUSTOMER DRIVEN ","2%, AAMV " m, low , zid,o'tgo� Office of f1r hmm 1.10 Bax%204 j Des lliira111a8. IIv0. 5Ci? Kama 515..:244 g9'; 4ISO SSM 1.121 p Fax5'15.„ 'pNi.,11�121i Inquiry Date: 3/6/2014 Norma Omar, Sawsan Khalil Addresol 1003 N BOSTON WAY City/Staten CORALVILLE, IA 522413116 Certified Abstract of (Driving Record DL/ID #. 059AA0923 (IA) Clasm D Audit Ra 7359065 Issue Datea 09/19/2013 Expiration 01/01/2016 Dates S92 Speed EndarsamentIn 3 Restrictionun NONE Date of Births 1/1/1972 Sam F Customer #: 1559313 ED Statuan None CDL Statuag None — CDL Cart Statum None CDL Ned Statum None Restriction None Supplements County Johnson Johnson Accidents - Accident Involvement indicated does NCFT mean the individual was at fault or given a citation. � Amildeint Bjai Cosa lallz.rddPilSw�i nil°:le. ..... .. ......2LIII1 liJVVr Q2 I' i MN < I 4 F M I t f In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa thk r„ A �:'®® ;3/ll/2014 History Information Convictions cih,atlollq ffbt&tw2 Conviction rate ACD ExpiamllgaUon 11/121201:11,. _ _.... 12/12/:011 .. , . _.. M14 �I'aM61I4IXll G71Mey'1C,N Traffic Btl91 00/2'i/2012 071111/'201°,8 S92 Speed Customer #: 1559313 ED Statuan None CDL Statuag None — CDL Cart Statum None CDL Ned Statum None Restriction None Supplements County Johnson Johnson Accidents - Accident Involvement indicated does NCFT mean the individual was at fault or given a citation. � Amildeint Bjai Cosa lallz.rddPilSw�i nil°:le. ..... .. ......2LIII1 liJVVr Q2 I' i MN < I 4 F M I t f In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa thk r„ A �:'®® ;3/ll/2014 Iowa CHmhial 1111istory Record Check WaW4R Request ORecord attached, DO ff DO Wtiala Receipt Nurnber of requests x $15.00 per last name = Total amount $ Method of'paymetit: Ocash Omoney order OdwelkEli�astckl'Ud oaVisa . . ... .. Lass 4 digiis of MC w V lisa m. DO 16flalg Credit Card Number # kx P, l We State of Iowa Division of (.76ninalInvestigation 215 E 7"' St Des Moines 1A 503;G 9 Ph. 5' 5,725-6066 Yax 59.5.425.6080 Iowa CHmhial 1111istory Record Check WaW4R Request ORecord attached, DO ff DO Wtiala Receipt Nurnber of requests x $15.00 per last name = Total amount $ Method of'paymetit: Ocash Omoney order OdwelkEli�astckl'Ud oaVisa . . ... .. Lass 4 digiis of MC w V lisa m. DO 16flalg Credit Card Number # kx P, l We