HomeMy WebLinkAbout15-1211 r t
CITY OF 104vf% a{TY
410 East Washington Strecl
Iowa c1t , Iowa 52240-1826
317 356-5040
(3 191 356-5497 FAX
1. Name (REQUIRED)
2. Mailing Address (REG
Authorization Number_ - / ai
(Office use umly)
APPLICATION FOR TAXI! MOTORED PEDICAB VEHICLE DRR1FR
(Police Department review must be mads between 8 a.m. to 3 p.m., Monday—Friday.)
Failure fo complete the "re ulred ' Informatlon will result In denial of Me aoplrcaUon
3. Contact Information (REQUIRF_D) EmaII: ojh;e).Q(&tbo2'701 emgx. (on, Cell Phone: s515 77/ O 6616.
4. Prior experlence In transportation of passengers:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? A/c?
Type of offense Where When
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last fire
years?4/ el
Tyne of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? Mo
Tyne of offense Where When
8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? yp_ S
lype of offense Where When
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9. Have you ever applied to be an Iowa City tab driver using a different name? If yes, please provide the name(s)
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DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE C�TIFIEjK
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEPSrVgV 'I
You must apply for an Individual Department of Criminal Investigation Retort (form avallabletf!]ponrNque#t.—
(OVER FOR REQUIRED SIGNATURE AND NOTARY).1 f
0912014
I hereby certify, that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
I understand that'rF I falsely answer any questions in this application, that this
appli 'on may be deni . I un erstand that if I falsely answer any of the quest ons in this application, that this application vAll
be deviled. I agree that in making this application, E wnsent ro 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. (Reads to be signed in front
of a Notary Public) r
Signature of Applicant
YOU ARE NOT VALID TO DRIVE ATAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY
CLERK'S OFFICE. Authorized taxi driver names are placed on the tidy website at Ecgov.org,
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STATE OF IOWA )
COUNTY OF JOHNSON )
S bscribed anr� sworn to before me by'"k rv,% R u�ngk � ��l�t .Ga r �{cEY ry On this 1�� day of
ky�r
Notkry,.P,C'�,Z��
ybli in and for the State of 00-d � /}
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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).
4<"a"' "'40e.
Sign re of Police Chi o 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 icgov.org.
Sign re of City Clerk or designee
/O Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'h" (width) and 5'h"
(height) and prominently displayed to all passengers.
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Office Use Only
Approved application
DCI report
State certified driving record
Website update
c�rvrnxoarlaknoEAPrw�4WM68aooc 0912014
Seo, 30. 2014 11:20AM
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'Sep. 25. 201411:55AM
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Div of Criminal Investigation
City Clerk City of Iowa City
STATE OF WWA
Cr(°j9Illlffiifl History Record Check
Request Form
TO; IoWADlvlslonofCrlmtaallavestlgatlon
6uppettopm'atlaua13mesu,i`a loon
215.1;. 7a'Strad
Des Maines, Iowa 40319
(915) 715-6066
(515)125.6090 Fax
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No. 0975 P. 1/9
No. Ob P, 2
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IrVOM: City aPlowa liCy
City Clerk's olflce
410 r.wae5fygtou
IOWA C M& 52240 '
,phgrfe; 319-356-5041
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d{veYrnfoJmrt(loft: Withouts rlgned waiverirom the subject or the request, n eomplote cxlmivalhis(ory rocoid may not
be releasable, per Code of Iowa,Chepiet 693.2, I+or co_ malate crlminn! history reeord InformatIall, es 2110w6a by law, always
Man a Waiver slpnpfinefrom the snbkcEofkharequaet..
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Tmose4gnFoa (OC>1. Asy rrimiaal history eat* cnertowag m that is mainland hydfo ACT n+aybereleescd as nRowed by LN.
10 CriX History ory Record Check.Desalts (Dcf Mons)
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As of l zO t a search ofthes provided name and date afhirth revealed;
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No Iowa CSrirrdnal ITstory Record found with DCI .,
0 Iowa Criminal history Record attached, DCI #F v
DCIWflals_AL—"
ARTS Page 1 of 1
I Ilk"
Mmiowadotgav
�twK.'s of DOM services
PO Ebur 9 i4 WhOes, A 90306 191W
F'Nor.w 510-244 tf'f7418DD-"iia-1121 i Fzc Sib4M4107
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Certified Abstract of Driving Record
Inquiry Date:
9/18/2014
DL/ID #:
673AJ0477 (IA)
Customer #
60demi
Name:
Ibrahim, Amin Mohamed
class:
❑
ID Status t
Nt ne
Adam
r r
r
1 'i
Address:
145 3311.1) AVE SW APT 28
Audit #:
8455005
DL Status: '� —
VAL
Issue Date:
09/18/2014
CDL Status:111, r,be
City/stats:
CEDAR RAPIDS, IA
Expiration Efate:
04/05/2018
CDL L""art S[a"I
'1
None
r� --
524044642
" r,
Endor rnrante:
3
CDL Med 6t itua:,
None
Mailing Address:
141 33RD AVE SW APF 28
Restrictions:
NONE
Resonation
None
Date of Birth:
4/5/1968
Supplement:
Mailing City/State: CEDAR RAPIDS, IA
Sax:
M
524044642
History Information
Convictions
0Wte Cozutction Dnte Co
ih & under In 35-55 rn
Name: Ibrahim, Amin Mohamed Adam DL/ID: 673AI0477
JU#;
rIA -
Pursuant to Iowa Code §321.10, I, Kim Snook, Director 0 Office of Driver Services, Iowa Department of Transportation, do hereby certify tnat 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 cumentiy in the custody of Bald
office, and that I have been authorized by the Director of the Iowa Department of Transportatkm to so certify.
In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa thls date:
Mama: Ibrahim, Amin Mohamed Adam DL/ID: 673PJ0477
9/19/2014
c
Orflce of Driver Services
Iowa Department of Transportation
9/18/2014