HomeMy WebLinkAbout15-215CITY OF IOWA CITY
Authorization Number
o W 5 1� of qx\ ,� -sr4 (Office Use Only)
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APPLICATION FOR TAXI! MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.)
410 East Washington Street
Iona City, lova 52240-1826 ?rgr:tlre tg Cp omnlete the ". rttouimd"information Will result In dental of the apolkat_ion
(3 19) 356-5040
(3191 356-5497 FAX
Firat Middl Csat
1. Name (REQUIRED)
2. Mailing Address (REQUIRED) 19 el gzl3a -
3. Contact Information (REQUIREIJ) Email:
4. Prior experience in transportation of passengers:
Cell Phor*-,; i�!R7
'fry es�4 w. q.i L-oo vret
6. Have you ever been convicted of any misdemeanors andfor felonies in this State or elsewhere?
Where
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?
.:. • it- t...
Where
7. Have you been convicted of any traffic offenses in the last five years?
Tvoe of offense Where
RE
8. Has your driveris Goense or chauffeurs license been suspended or revoked in the last five years? NO
Typeof 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 db§TIFIO
DRIVING
DRNG RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF' E W ^� -
You must apply foran Individual Department of Crlmhml Investigation Report (form available.0port request).;
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
0912414
I hereby certify that I have issued to me by the Iowa Department of Tiwsportaticn a •radia Chauffeur's license number
0 z/6f A % "N C,' .22, --7 . I undestand that if I falsely answer any quesiicns in this application, that this
application may be denied. I un erstand that 91 falsely answer any of the questions in this application; that this application will
be denied. I agree that in making this applicaton, I consent to ailow 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 compty at all times with all of the provisions of Title 5, Chapter 2, of the City Code. ;-'lesrie tc to eignad in ftn'
Signature of ApplicanDate_L 3 P
YOU ARE NO1 ALID TO DRIVE A T AX: IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY
CLERICS OFFICE. Authorized taxi driver names are placed on the city website at Icgov.org.
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STATE OF IOWA )
COUNTY OF JOHNSON }
Subscribed and sworn to/ before me by ) r 25 �i . A-1 t�
A �t . On this day of
.n -II
n " i M 0 fi . '8- Tri. (� lr "Lau <s" afl"''�e
I have reviewed this application, DCI report, and the State cedfffed 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 ori a ief or designee
�
ate .
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 icgov.org.
Z/1�
Signature of City Clerk or designee
Oka
Taxi cab businesses are required to provSde Driver Idan iffcation cards. CaidS tiluet w3 8 %" (width) and 5'/s"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DO report
State certified driving record
Website update
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PFJ 909 i3M r Ons MQ%oa, fA 50306-9204
Pticce: x15-214-E1i34184Mi1 -i92i i.Fa :!M-231}'$8:37
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Certified Abstract of Driving Record
Inquiry Date:
1/23/2015
DL/ID O:
24BAD4337 (IA)
Customer *:
5409180
Name:
Ahmed, All Omer All
Claw:
D
ID Statue;
Nona
Address:
2401 BARTELT RD APF
Audits:
7392384
DLStatus:
VAL
IA
Issue Date:
10/01/2013
CDL Status:
None
City/State:
IOWA CITY, IA
Expiration
09/22/2018
CDL Cart
None
522462701
Data:
Statue:
Endorsements: 3
CDL Mad
None
Status:
Mailing Address:
PO BOX 2532
Restrictions:
NONL
Restriction
None
Date of Birth:
9/22/1968
Supplement:
Mailing City/Statat IOWA CITY, IA
Sax?
M
522442532
History Information
Convictions
Citation; Date, ConvIcUon Out* ACD Explanation County IDI:
09/Q 1/2[112 11/QBJ2Q12 ;M14 .Pall to Obey Fruffc Sign/Signal 3ohnson IA
Name: Ahmed, All Omer All DL/ID: 24RAD4337
Pursuant to Iowa Code §321.16, 1, 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 mid office, and that I have been authorized by the Director of the Iowa Deparbnent of
Transportatlon 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:
9k[f �• 1/23/2015
........
. Office of Driver Services -
Iowa Department of Transportation
Name; Ahmed, All Omer All DL/ID: 248AD4337
Jan, 24. 2415 4:46PM Div of Criminal Investigation No. 8380 P. 1
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To: sown rtivislon of Criminal bwesll¢atfon
Suppartt3peratioasHureaY, eplomr
215' R. 7`e Sheet
]Des Molltie% Iowa 50519
(515)725-6066
(515) 725.6010 Fax
X am reausstimr ma lowa Crimiaai Ilistwy RcooLd Check on:
bClAcoouutNumber; d-f^00� — F
ptepp)f ro)
rrom: C1(yofXow&gk
Chy Clerk's 010co
416 �,'Washi�tosr Street
Iowm i'ityr U .522.80 .....
pilaris; 319-396,6041
pvar; 319.356.5697
Lao Name (mtmmo,
Fir8t Name apodatnry) _
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h
)late of Birth(mandu[ery
Conder (- a owwy)
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WadvwrXnfOD?xatt'mt: Without sigrad waiver ftm trio au6]ectUthe request, a complete a lminellhistory record may not
be releasable, per Cade otrowa, Chaptor012. For eomoddo criminal bdatory record informat►on, as allowed by law, always
optAln_a wait' al�aatnra from thesublcat of trioro6u�t. __
Wadver!S~edea d, lMraeeygiro pom,*ssionitapa abew ropoWunmdatio conducraotnwa eduf al llidoryrowd clod with Lha Diviaian*FOWidl
brorclgsNart (f>C}}, Ar1y a,imtgp[ hGtory data sonwAdngr+e slat IamslnWneA brrae DC7maybore[eased w a0ow�d ay Inw.
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As of� a, search of the provided panto mud dato ofbiob revealed
No Iowa Crinilnal iiAwy Record found with 1) Cl
fowa Comiaai History Record attaoh.od, DC1 #
DOAni6a15�_
Received Time—Jan. 15.-015— 4:24PA4-No.893
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