HomeMy WebLinkAbout15-141IDENTIFICATION NO. /t5— J �,4 l _
(Office Use Ohly)
APPLICATION FOR TAXICAB I MOTORIZED PEDICAB VEHICLE DRIVER
CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday – Friday)
410 Cast Washington Street
Iowa City, Iowa 52240-1826 fWIUM t'O r;CMtF El{'e fere "A_eCfUfCeC(" 1P)forrnafion t4rdfl result in deni3/ of the aaj2pficaaon
(3 19) 356-5040
(3191 356-5497 FAX
First Middle as
1. Name (REQUIRED) Y 1,1-9 Y NA N
2. Address (REQUIRED) Ibi-3 3 z
3. Contact Information (REQUIRED)Email:�:aAM#-d.comCell Phone: Cirl3Vk1
(All written communication sent via email
4a. Chauffeur's License expiration date (REQUIRED)
b. Taxicab Business Name (REQUIRED) r�Teo�
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
7. Have you been arrested / charged with any traffic offenses in the last five years? Z a
Type of offense Where When
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?
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)
1j
0212015
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
issued on expiring on . I understand that if I
falsely answer any questions in this application, that this application may 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 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 n Date �e,(
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by A o ujc� VA A A 6 i1..cdbg on this 1 —7 day of
i n i.a -)-DIS .
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
M
Signature of�P e Chief or designee Date-
AFTERAPPROVAL 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.
ig� nam of City Clerk or designee
Office Use Only
Approved application
DCI report
State certified driving record
Website update
7
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arnorvaDRIVDAocraaat92DI4a ,ded.00c 03/2015
F�Jul.lpIUIi 11: 4'dAM= erlUIv ut Giimina,I Investigation No, 2//d ii[
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STATE OF IOWA
CrimiAal Nisfou Record Check
Requt,�st Form
fMva DwiAuu of Criminal Dwemgatinn
Support Operations Burcau, 1" Flour
215 E. V Street
Des Moines, Iowa 50319
(515)725-6066
(515)77.§-6080 Fes
41111,
�e veslin an JOWL Liminal 1Jistali Record
Last Faint (mAodalo") first
c�
Date of Birth rmsndarn , f�.:.A,
DO Account Number / OL-),) - F
From: alty of IaN'a ai[y
City Clel-Ps Office
410 E. W6sllinkfop 3trco
lorya Cid IA 52240 _ _ _� _�
Phone: 3J 9-356-5041
FeBc 319.356-5497 --- —"
k
Name
11 I3 _ �hrtale ❑Fenfaie �j � 7 _9 O —
Flrnrne//xfOrrrtatlUra: Without a signed Ipalver from the subject of the request, a complete criminal history record may not
be rcleassblei per Coda 01' lolya, Chapter 692.2. Igor connle[e ci iminaI history retard information, as ahowed by laH', always
Obtain a fl�� alver�si r�ture from the subject of the reauesf.
WIlfiVer Releryre; I bcrcby give p<missiaA for rhe eboyc requesting official to conducl an 10N'A criminal hismp record check with the Div,;= of Crimij a
I vtMgmiormcl). Any Cfimirlel hlSlOf'dal8 co ccr
., y DCI may bo rcicascd a$ a7lo,rcd by law.
1 �! Ihlis mainlaioedb the M44
As Of search Of the pfovided name and date of birth re
m #
No lows C:'riroinzl] Hisloq' Record found wi(h DCd
❑ 10 CD
Iolwx C'aiivnnal Historq Retard attached, 1)C1 # CDDt -=
�+ N
DCII initialso-
DC1.77 (08/25/10)
Received Tlme Jul. 9. 2015 11:59AM No -2646
(DCI use 0111))
-�71
Page 1 of 1
---�'WVAV.iovvadot,gov
a�tt�,rEF; _<<<r,tF_� i Co5ro�aERrVL d
Office of Driver Services
FO Box 9204 Des Moines. L4 503D6-4204
Pho:e. 515-244-4124 1 8D0-532-1121 i Fox 515-239-1837
wwwl0wadot.gov
Certified Abstract of Driving Record
Inquiry Date:
7/8/2015
DL/ID #:
126AC0752 (IA)
Customer #:
5227858
Name:
Abdalla, Morwan
Class:
D
ID Status:
None
Mohamed Ahmed
Address:
1437 FRANKLIN ST
Audit #:
5493288
DL Status:
VAL
Issue Date:
09/07/2011
CDL Status:
None
City/State:
IOWA CITY, IA
Expiration
07/13/2016
CDL Cert
None
522402710
Date:
Status:
Endorsements:
3
CDL Med
None
Status:
Mailing Address:
1437 FRANKLIN ST
Restrictions:
NONE
Restriction
None
Date of Birth:
7/13/1968
Supplement:
Mailing City/State: IOWA CITY, IA
Sex:
M
522402710
History Information
CLEAR DRIVING RECORD
Name: Abdalla, Morvan Mohamed Ahmed DL/ID: 126AC0752
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:
e: """"• ;�i,p'y
7/8/2015
IOWA
BBIyE6 �O=
Office of Driver Services
Iowa Department of Transportation
Name: Abdalla, Morwan Mohamed Ahmed DL/ID: 126AC0752
7/8/2015