HomeMy WebLinkAbout15-190IDENTIFICATION NO.
1 l t (Office Use Only)
APPLICATION FOR TAXICAB ! MOTORIZED PEDICAB VEHICLE DRIVER
CIN OF IOWA CITY 7
(Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday)
410 Last Washington Street
Iowa city, Iowa 52210-1826 Far1EF£e t0 cOtiF EPe fire "1-e 111t'ed7"' (t7taen3afiotT tYi{l1ESuPt/t7 n`eni�l of l'hB a[3p1FCai'lop
(3 19) 356-5040
(319) 3S6-5497 FAX
First Middle Last
1. Name(REQUIRED) jrt dA(--% 1(rs 11eimtrt t%a {.bdia Ila
2. Address (REQUIRED) )-F; Z& r�iir vt�1 4 2
3. Contact Information (REQUIRED) Email: ()r LUl 2 3 ( q A -t& _ t - Cell Phone k`A 3 27 7) L
(All written communication sent via email)
4a. Chauffeur's License expiration date (REQUIRED) cz Ll _ c>
b. Taxicab Business Name (REQUIRED, -C� 4�� � 3
5. Prior experience in transportation of passengers: 1 i/ (i ,1%�-, _ Y t),- VAI r! 0 e P j ( !at n J G rV4? tt «s�
6. Have you ever been arrested /charged with any misdemeanors and/or felonies in this State or elsewhere? A/C;
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?
•� r
T e of offense Where When
k,o r s; 5 201
SPA 7ZI4 Gli;l
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? Ah-)
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)
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
!ti '5 0 G V•ZTZ Fy �5 issued one xpiring on f �c 'c. I understand that if I
falsely any questions in this application, that this app cati n may be denied. I gree ht at 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 ofA Applicant Lia i qA rD
9 pP g pk�l (tet Date 7_ � V^ 2 o I h
STATE OF IOWA )
COUNTY OF JOHNSON )
Sub crib and worn to before me by K(�i G[t��C� on this day of
7A� KELLIE K. �
TUTTLE''-"e" 'r
n ;1nmbgr 221819 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 C I2S I2 -p2 n
Signature of Polick Chief or designee
o73o1S
ate
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.
A
Signa re of City Clerk or designee
Office Use Only
Approved application
DCI report
State certified driving record
Website update
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Dat
cierwrAXIDRroenocEAPar9201 �,ded,Doc 0312015
f�ZIrDDT
Office of Driver Services
PO Box 9204; Des Moines, IA 50306-9204
Phon- 515-244-9124 ,800.532-1 121 1 Fax- 5115-239-1937
w Jowadot.gov
Inquiry Date: 6/30/2015
Name: Abdalla, ]alaleldin Rahemtalla
Address: 2525 BARTELT RD APT 2A
City/State: IOWA CITY, IA 522462718
Mailing Address: 2525 BARTELT RD APT 2A
Mailing City/State: IOWA CITY, IA 522462718
Convictions
Certified Abstract of Driving Record
DL/ID #:
459AF2353 (IA)
Customer #:
5741899
Class:
D
ID Status:
None
Audit #:
8841421
DL Status:
VAL
Issue Date:
02/12/2015
CDL Status:
None
Expiration Date:
04/25/2020
CDL Cert Status:
None
Endorsements:
3
CDL Med Status:
None
Restrictions:
NONE
Restriction
None
Date of Birth:
4/25/1974
Supplement:
Sex:
M
History Information
Citation Data Conviction Date ACV Expianaticn County 7[1F..
01/28/2014 02/06/2014 S92Speed lohnson IA
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accidont Date Case Number 3UR
12/08/2013 :.773179 _.
IA
Name: Abdalla, ]alaleldin 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:
Name: Abdalla, ]alaleldin Rahemtalla DL/ID: 459AF2353
6/30/2015
e
Office of Driver Services
Iowa Department of Transportation
L . ntIu �f.I rlvi uiv of �rlmina, investigation Na 0314 P 1/I
F . , • •—,-r — --I- — , Cl or- — -- — --' 08/30/2016 14:x- d11D . —2/002
STATE OF IOWA
6) (—'r'h aival History Reeor(i Cheek
Request norm,
fo: l)faa llivieiun o1 (S•immm lgvestigafion
S lippart Operations Bureau, 1'� hlom•
215 E. 7" Strnet
Des Moines, luwa 50319
(515)72'3-6066
(515) 725-6080 Fax
Iowa
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to
))CI Acctnan( I\Ilnuher: 7L2:5a -/15'
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Prom: CC ofIowaCi[tv _
City Cloth's Uffice ��---�'��---
4101s. Washin Ion Sweet
_10W_2 Cf lA .52240
Mimic: 319.356-§'041
Fax; 319-3.56.5497 --
91
" LI I LIale �Femalc
Inf
e rel e7• able, Per Code: fowwithout a signed�ep (from the subject of the request, a complete criminal history Pccord may not
be releasable, per Cade of low Chapter 692.2. For com le(c criminal history record iaformatiola, as allowed by law, always
obtain as w9 iver nsJure from fhe subject of the reouest.
i'I�RIV¢Y %tei¢/ISe: I
Anvmin give pemiisaionfor aha above raqucsling vfficl9l iv tootled art Iowa criminal hismry're��r�) Check wish the 4i1'ISien of Criwival
Invesligafion (nC1). y erirninal bislory Bala concreting me thaf is maimainW 6y Vet DL'I may pe released as e)Ivwed by Ian,
N/ River Sid hatm,e:
Iowa Ctilninaistur Record Check Resu[ s
As of search of the provided name and date of hir(h reveal v' f � i
-23
No ]owa Criminal ]-"story Record found wilh DCI
> U �;
]owa C1IIII tnal F3iMwy Record al(auhed, DCII iJ�_ x 5
DCI initials
L)(.,')-77 (08/25/10) -------------- -- -----
Received Time Jun. 30. 2015 2 : 5 2 P M No. 1932