HomeMy WebLinkAbout15-151ww®o®
aMMOT
CITY OF IOWA CITY
410 East Washington Street
Iowa City. Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
1. Name (REQUIRED)
IDENTIFICATION NO. —moi —J C�)
(Office Use Only)
APPLICATION FOR TAXICAB / MOTORIZED PEDICA$ WHROEE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday)
cafiure to complete the "required" information will resultin denial of the application
Middle
Last
2. Address (REQUIRED) )—AZj; (i isrfi�l} ah 2A n/4 L,i1 '6 9.2x46
3. Contact Information (REQUIRED) Email n-1.�� 2 �) (� N fin, A ce,w Cell Phone(' t-
c �•
(All written communication sent via email)
4a. Chauffeur's License expiration date (REQUIRED) O ._
b. Taxicab Business Name (REQUIRED) r�oWa_ n C;rlt Y l r�
5. Prior experience in transportation of passengers:
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere?
Type of offense Where When
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty Other
Have you been arrested / charged with any traffic offenses in the last five years? ""IND P rz
Type of offense Where When
s�neel �ra rllo rt Zot'1 ple�A�h()
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty Other
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? C)
6
Type of offense Where When
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW
You must apply for an individual Department of Criminal Investigation Report (form available upon request).
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)
02/2015
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
L4 V:� Z t'j issued one xpiring on C4 c ^a. I understand that if I
falsely answer any questions in this application, that this app cat be denied. I gree that inmakingthis 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 authorization to be a taxicab driver 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 r'. a 4!PZ L ( Date e} _ 2 o I h
STATE OF IOWA )
COUNTY OF JOHNSON ) / _ I /
'Sub`cc bed and _§wom to before me by �. cc-�-� e f0(r1 �K, �T CLL onn thiisn �r`L day of
(� of -0 ,T,� KELLIE K. TUTTLE
c Trni t, n �hmmagt 221516 Notary Public in and for the State of Iowa
I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that
there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi-
dents of the City of Iowa City (Title 5, Chapter 2, City Code).
Expiration date of Chauffeur's license
Signature of Policb Chief or designee
oilI2,I L"',
— Q7 a15—
Date -
AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO
MORE THAN ONE YEAR FROM THE DATE LISTED BELOW.
✓l �
Signature of City Clerk or designee
Office Use Only
7 2e 115
Dat
Approved application
DCI report
State certified driving record
Website update ; 0 2015
Cl., AMIDRIVBADGEAPPL92014a.endedDOG 0312015
Q-01111111110,4JOWADOT
SMARTER 151?r1�'LEF; I CU>TO7 i E DRJVE�4 VIiPv.i[�V/�C3i7�.�IIV
Qf&-e of Driver Services
PG 1301, 92041 Utes Mcsne5. IA 50306-9264
Phc e '115-244-9124 1 900-53E t 121 I Ta 1,1 Fr239-1937
Vem; rawadot.gov
Certified Abstract of Driving Record
Inquiry Date:
6/30/2015
DL/ID #:
459AF2353 (IA)
Name:
Abdalla, Jalaleldin Rahemtalla
Class:
D
Address:
2525 BARTELT RD APT 2A
Audit #:
8841421
Restriction
None
Issue Date:
02/12/2015
City/State:
IOWA CM, IA 522462718
Expiration Date:
04/25/2020
Endorsements:
3
Mailing Address:
2525 BARTELT RD APT 2A
Restrictions:
NONE
Date of Birth:
4/25/1974
Mailing City/State: IOWA CITY, IA 522462718
Sex:
M
History Information
Convictions
Customer #:
5741899
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
ci"aVen Date comic- ion Date ,:XD Ex ianatian
Ooun�y 3U*•
01/28/2014 02/06/2014
592 Speed .Johnson IA
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
.'ecident Date Case Number 7UR
12/08/2013 773179 IA
Name: Abdalla, Jalaleldin Rahemtalla DL/ID: 459AF2353
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.
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:
s®�®�VF,Nltlf Bj`��14
sIIYEa i
Name: Abdalla, Jalaleldin Rahemtalla DL/ID: 459AF2353
6/30/2015 �tI"
Office of Driver Services
Iowa Department of Transportation
dui. 1' LUI) 4:I5rivl 01v of Grlm;naI Investigation No. 0314 P. 1/1
F=1 ......-.,,y -.� ,n.- —,clern v�.w� v..., oe/30/201E ld_�. gldc, ......d/002
STATE (IF IOWA
Criminal Histo€ -y Ilecord Check �>
4 Request Form
Co' Iowal Uivislon ul C'r•ihimal Invicetigatirvl
Supp orf C}perat sous furca u, 1" Floor
215 E. 7" 5[reel
B_s Moines, Iowa 5031y
(515)726-6066
ISIS)725-6080Fa>
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City Clcrl4s Clffrcc ��----' l--'-
410Is. washin Ion Street
Iowa C� IA .52240
Phone: 319-3S6-3041
Fax; 319-3565497 ---
Social
2<ale El Female G a 1-{ — 6 � 1 `I 6i
rrgrver Injormation: without a signed tvaivel' from (Ile subject of the request, a complete criminal history record stay slol
be releasable, per Code Of Iowa, Chapler 692.2. FO, C011100 criminal history record information, as allowed by law, always
obtain a w� eirersignaWIT from ())e subject of the reouest-
WR[VeY RPieR3e: I hcleby give permission
Any for rhe Abol'e rcquesl ing efficiel to co ndutl fill Iowa Criminal hismry reeord check wink the Vivision of Cfiurinal
Invesligalion Incl). criminal history data concnnhlgme Thal is maintajnrA by Or, J)Cl maybe released as allolved by Irv,
-1
Jilaiver SlPhnhm,1 o. _ A/—/Um
Iowa Criminal Iiistor I�eco1 d Check Results
_ r -
As of —z a search oftbe� troy
L�ryp['7I } ided name and dart, of birth rev�eale;,
1 \ (s'; r;
No ]nw;r (;riming] liislury Record fowtd with UCl � [ '
]Dura Criminnl Histo. I TZCcoid alleched, WA 11
—_ UC.1 initials. -___CD
3 0 2P;5
Received Time Jun. 30. 2015 2:52PM klo. 1932