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HomeMy WebLinkAbout15-123I P 3 ��r .:®ski CITY OF IOWA CITY 410 East Waskington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX fey S Q [Authoriz on Number C6f (Office use curry) APPLICATION FOR TAXI! MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday— Friday.) Failure to comolete the "recrulred" lniormatfan w111 result in denial of rhesa l�r�Pcatton First 1. Name (REQUIRED) 2. Mailing Address (REQUIRED) i 3. Contact Information (REQUIRED) Email Mlddle e8ell Phone: M 4. Prlor experience m transportation of passangem: I have 40" r't R AriW 1 4 arour foe4m Ct �Q f U�ePa trS . 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 6. Have you been convk:ted of operating a motor vehicle while under the Influence of alcohol or drugs in the last five years?440 Type of Offense T Have you been convicted of any traffic offenses in the last five years? 4/0 EM B. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? &19 TV1e of offense Where When 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes. please provide the r@he(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE (.` "FIL'D 17Z DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHI MITI AEW You must apply for an Individual Department of Criminal Investigation Report (form avallatiie'oporfiiqueit)., (OVER FOR REQUIRED SIGNATURE AND NOTARY) 0912014 I hercertify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number eb i -7`% � b . I understand that if I falsely answer any questions in this application, that this application mal tie denied. I understand that if I falsely answer any of the questions in this application, that this application vrili 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 atall times with ail of the visions of Title 5, Chapter 2, of the City Code. (Weeds to be ergred. rn ftnil of a Notary Public) Signature ofApRJ = f Date L l r� �lI YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERKS OFFICE. Authorized taxi driver names are placed on the city website at legov.org. 41#iM*ikMIkYMM M4.!!M*'%Ii�*R#*'M*MYW*'MII*Mk%M%M }*[**%M}Mk%+MMM*M**MM*RMMM*MMn4%I.FR#*IN#i*iMMk+e:lRlr!*YNrA 40�1R*efhh*M�MLM*} STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by , )-Z,-,'t N rk li,bQl gl On this 7! ` 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). Signature li ief.or_d riee Date YOU AR NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERKS OFFICE. Authorized taxi driver names are placed on the city website at Icgov.org. 2?1k. d a Signa of City Clerk or designee 1,2-1111 el ate 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. Office Use Only Approved application DCI report State certified driving record Website update �w3NUVMVGWPL92a 4WWKWD0o 09/2014 Inquiry Date: Name: Address: City/State: SMARTER 1511,44 1P 1(USTUNIEi MV 13, office off;fiMset ices PC) Bo:: 9204 i Des Molrw% €h %306-W234 F'haaw 515-244.8124 1 Gf.Mi SMS 11211 Far. 555Ii.x39-1?33I www_klyradofgw 12/II/2014 Abdallah, Elfatlh Hussein 16 ANISfON ST IOWA CITY, IA 522402216 Mailing Address: 16 ANISTON S'T Mailing City/State: IOWA CITY, IA 522402216 Convictions Certified Abstract of Driving Record DL/ID V; 617XX3816 (IA) Claes: A Audit s: 7169570 Issue Date: 01/25/2013 P.IWIration 06/21/2018 Date: VAL Endorsements: NT Restrictions: NONE Date of 111rth: 6/21/1972 Saw M History Information Customer*: 2345972 ID Statue: None DL Status: VAL CDL Status: VAL CDL Cert Excepted Interstate Status: ..-.—�A CDL Ned None status: Restriction None supplement: CitaUan slate cant Ichors ID cx:al7natlon Coonty 1[-111 01/13(2013 ,0".L/21/2013 =592 ;Slued .iowe 1A Accidents - Accident involvement Indicated does NOT mean the Individual was at fault or given a citation. Acck'ant DataCace f3um'oer `DR 11/20/2009 ... ., _._. _- X472653]A ....... ,. ......',578332.... _ ..,.._....._ ....,..__... ..... ,IA ... I 12/03/2011 ............. _... X660530 ..-.—�A Name: Abdallah, Elfatih Hussein DL/ID: 617XX3816 .' Pursuant to Iowa Cade §321.10, 1, 10m Snook, Director of OMce of Driver Services, Iowa Department of ';T hansportatlgn, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this i5'a,t'tfie a0accurateaopy of an oMcial record currently In the custody of said office, and that I have been authorized by the Direco" the Iowa Department of Transportation to se certify. In witness whereof, I have reused my signature and the seal of the Department to be set upon this doturrent. at Ankeny, Iowa this date: IOWA _i` -Ei n n T dao 12/11/2014 Dec, 1, 2014 MOM Div of Criminal Investigation No -5244 P. 5/5 ", cu 17 T,V[1m V1 rr r1toA oily el lewd trliy bo. h4ji P. C NTATE OF IOWAIs l 1,ire ,l.��d 1. l Requeft Forin To: rowalllvWonofCrludkiallltvatigaldon Support Operatlaus Hurenu, i" Floor 215th 71" 84radt bd2Mb1n0;1o7ra $0319 (515) 7254066 (515) 725-6080 Fag 1 am reauesthlo an Iowa Criminal IiismrvReocu d Chock on: )DCIAceonntNtanber.,___'9 ✓_'.__ *Orf, Cit owa Ct Cly' ciork's Office 410 P. washhlgton St eef Iowa CI 1'A 32440 none. its-33'S.80a1 Fax: 31935"4pr LastName(m.1dMwrl Mrst memo m.vdrrwy) � boAdleName (wWw tmeA hid A(Iu k Date o£Birrth tmsodslary) GcndeY ma talo J� N� Selo) Saeurit IQttmbor (.eepm ualdrd 6 00 V71 Mala ©Female PYetfncrl'nfforrM&N. without signed waiver from the subject of the request, t complete crl;a n4 history record Fray not bo rcloacablc, per Cade of Zown, Chapter 691.4. For coF pWo criminal history record infornm%Uou, as allowed by law, always otrtalnaWplytrslgnsWrefromthesrthlectotthereguwd: _ �.�_ WajVer.R81l.jUe:1hun6yglvo Dnhdes'rwj for0t*no rcqumling olrccl&l lo toAdetl an rows _ Wibb yrecnrd th ok with 9A bWae#901tehul hsrarAplE lQ.lt:Q. Anyc*u4 l hNoy dice commrtogals lief rsm6fiW rAbyftl)cfmtybfl manowdbyla;r, W47tvarSignatrtrel ro rlminat histo � Record Check Resifts � ..� rY � As of � j / � a. search of the provided mute and data ofbhtth rovealcd No TOv9a Criminal History Record found wltli DCI 11 Io'lva Criminal Mstory Record attached, DCI I)CI initials deceived Timeq_Nov_Z5,1(2014 MO No.5955