HomeMy WebLinkAbout15-122CITY OF IOWA CITY
410 East Washl ngton Street
Iowa Clty, Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
Authorization Number j S — ) a
(Office Use Only)
APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday— Friday.) `
Fallure to complete i1 eq rewired information wNl result In denial of the appftcadon
FI +
1. Name (REQUIRED) 51
5 �tA P-
2. Mailing Address (REQUIRED)Lt i j 7 eV 5 I "tee C t Lo I. N c ti H +; i 7 qui
7
3. Contact Information (REQUIRED) Email: C4 1 '- A6-, 44 04,0 G, --(—Cell Phone: 7-6:15'714331-7
4. Prior experience in transportation of passengers: Z W011/- -i' X i i v t y
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense Where
I j
g sjSi 46h n.eK x ✓CaK'
6. Have you been gonvlcted of operating a motor vehicle while under the influence of aloohol or drugs In the last five
years?�fl b
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense
When
When
B. Has your driver's lioense or chauffeur's license been suspended or revoked in the last five years? �j t)
When
9. Have you ever applied to be an Iowa City tali driver using a different name? If yes, please provide the We(s)
Nf 0
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE Ii�RTIFµM
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHmF1 -.
You must apply for an Individual Department of Criminal Investigation Report (form avallabIWupgrFxequn
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
crr
09/1014
herebyce 'f� at ve' i�su to me b the Iowa Department of Transportation a valid Chauffeurs license nLMber
' A� 0t y d 4 y. I understand that if I falsely answer any questions in this application, that this
application may be dented. I understand that If I falsely answer any of the questions in this application, that this application Oil
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. (heeds to Ce signet! In front
rf a Notary Public)
Signature of Applicant �/f4Y 1� r �� 'l'� Date Ve^"� �) _ 20/q
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 city website at legov org.
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and swom to before me by 1{C74>'r S.. A)AL1. elL.�«v . On this L)5� day of
^r-�, A, , 1,�Ir '/
I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter-
mined that there Is no Informatlon 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 �' t r designee pate
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 an the city website at Icgovorg.
ign turegf City Clerk or design
Di to '
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'W' (width) and 5'/:"
(height) and prominently displayed to all passengers.
♦xv++wv�+a+++++r++e++++++r.++++rtr+n+rt+++e++wow+r1,++.e+++e+xr+++w+r+e+„n:++»ee+err„rw++++++wne�w++e++e+x+++x+++++.++++e+++++.++e�+++++..wa.+++:+++
Office Use Only
Approved application
DCI report
State certified driving record
Website update
CW,r[AIcwcwasoceaPPL9=amwaa 092014
Oct. 21. lull 1I:Airm
UcL LI. lull I:.41rm•
sale
Div of Criminal Investigation
"Lily Werk — l,lly OT lewa bl[y 7,.
RA'C'E OF IOWA
Criminal ffistory Recur Check
Request Forel'
TO: Iowa Division of Criminal Iutrssllgatloa
Support t)perlttlons Bureau, la noot•
215 & 71e street
Des Moines,IOWA 30319
(515) 723-6066
(Ms) 725.6080 Yron
Y am reouesthxe An Iowa CrImbutI Hiatow Record Cluck ax:
hao'�j44 P. 11
,DCIAooDDnt)Sutnber: Ubh1,j✓
(rrapplisxbtc)
Irrom: City of Iowa city
(ity0erk'e Offim
11011 ,M2ehtagtoatiheet
Iowa Cltgs 7A 52240 --
Last Name
-
LastNamo(nunQatarfi
FIM NAM Gny)
Middleblame(ttuonvurcle
Date. of PlirtlrgtmaWetory) _ _
Cxertdor menaaMry)
Social 9ecttrit* .,
f�om,aw
2 f' /q
duffle ditomala
Numbbelrr
171, 76— 96# r5
Flyatvewlr{fowmaliok; Without signed waiverftom the subject of the request, a complete crlmlmd history record may not _
be relcatsable, pot Cake of Iowa, chapter 6M k+or gomolylp erlinlaat btciary record Informagon, as allowed by 1ww, alwssys
obtain it wgMe alanature train the attbled of tha rdousst. r
Waiver Release- llaeby give innnWido fordto rbwo rogpulinaotDddia eons m towfi ahkiel history sword d,eelc. ilh am Dtrtslon ofcrbwnw
lnresliWon MM. Ally orka nst h44W dim e,�Lappse-mInsino Mat is vulhlaW hyd�c DC1 may bb nfcpoe u ellowed lyhw.
Waive),Strnalawe:#�Y
n4arintory Reoowl CCheckf - (nclef� ayy
As o1 A a search of thepxnvided Dame and data of binth a-svqlb ed
No Iovm Criminal Hiswty Record found with DCI `5
�rr111 /
Iowa Criminal HiatolyRccord attached, llCi#
Minidats i1_0_ _
Aived 7imer9)t1.21.'12DI4 1:39PM No.3561
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Inquiry Date: 11/20/2014
Name: Abbashar, Yaslr Ibrahim
Address: 2424 BITTERSWEET Cr
City/State: IOWA CITY, IA 522464100
Melling Address: 2424 BITTERSWEET CT
Mailing City/State: IOWA CITY, IA 522464100
(Mice of Ilam Services
Ft? Doe 8204 ! 1)K :IfriklW bt 503D64X4
Man* 5115...244 91241IPM-3Z 11.11 i. Fax: 5-5-233-1837
www.tawadt><,gav
Certified Abstract of Driving Record
DL/ID 4:
658AI5404 (IA)
Class;
0
Audit v.
6595404
Issue Date:
01/03/2013
Expiration Data: 04/29/2018
Endorsements:
3
Restrictions:
NONE
Date of Birth:
4/29/1972
Sax:
M
History Information
CLEAR DRIVING RECORD
Name: Abba::hap Yaslr Ibrehtm DL; ID: 558PLs404
Customer W;
6051382
ID Status:
None
OL Status:
VAL
CDL Status:
None
CDL Cert Statues:
None
CDL Had Status:
None
Restriction
None
Supplement:
Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportatldn, 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 try the Director of the Iowa Department of Transportation 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 this date:
t�,114 '
11/20/2014
-'IowaP.
Y
•..
Office or Driver Services
Iowa Department of Transportation
V:.
Name: Abbashar, Yaslr Ibrahim DL/ID: 658A75404
CX;
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