HomeMy WebLinkAbout15-248Ej`�Ip IDENTIFICATION NO, f S
(Office Use Only)
t' Kl� 1 I I
CIN OFlow
410 east IA ACII-i pPPLICATIONFOR7AXfCgB/MOTOR
ashingtnn Srreer (Police partmentr
lnwa city, roma 52240-1826 _F_ ,ilure tc cu '' review must be made between ng a mlCAB VEHICLE DRIVER
(319) 356-504 -
1319135r,-5492 ur+i'= uG ;t +ntur,r, P"m"Monday-Friday)
FAX �e£int-lyllllt•,
u''/r�denial �l t9i�acyr�,l�aticn
Name (REQUIRED) Jst��First
�r�_I Mlddl
Address (REOUIREU e
3. Contact Inforrn )*' last
atlon (REQUIRED) Emarl:
,12 ---
/All I N f n
4a- Chauffeur's License `rt cc),,
Cell Phon
expiration date sent via email) L`! _)_
b. Taxicab Business REQUIREDr OLA
Name (REQUIR ` 2�Z
5. Prior ex
Aenence rn transportation EO
tinn cfpassengers:-��—
6- Have
offense ` ° �rLird�
YOU ever been arrested /char �—
!Wt- of charged with any Misdemeanors�-
and/or felonies in this State or
Where elsewhere?`
_ W-
What happened to the
charge? (Circle one) — —�—
Convicted Dismissed DeferredHave you been arrested / charged withSuspended
T o of offense any traffic offenses in the last five Plead Guilty Other
years?
Where
rz
man,
Whathappenedtothe (Circle
charge? I 2
9 One) n
missed r l }
8. Has yoConvicted Dis
ur driver's license or chauff'
eurs license been Deferred
Tyoe of offense sus Suspended Plead Guilty Other
herded or revokedWhere in the last five years? !�
� When
9 Ha� u ever applied to be an Iowa City taxi driver usin '
—�� g a different name? If yes -
-- - please provide fhe
DEPARTMENT OF CRIMI rame sl?
DRIVING RECORp MUST NAL INVESTtG
ACCOMPgryy "HISATIAPPLICATION
(DCQ REPORT AND ST
You must apply for an individual I) APPLICATION F ATE CE
partment of Crim, OR POLICE C REVIEW nminal Invest) HIEF REVIEyy
(SECOND PAGE F Investigation Report (form available
OR REQUIRED SI upon request).
GNg7UREgNp NOTgRy)
o2nn,�
APPLICATION FOR 1 AXICAB VEHICLE DRIVER
Page 2
1 hereby Certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
issued ori xpiring ane c•''c. I understand that if I
falsely answer any questions in this application, that this app cati n may be denied. I gree hat 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 furher agree that, if authorization to be a taxicab driver is granted, to comply at all
times with all of the provisions 1of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant , g�l y pl�Lri _ Date
*�uµtkkhwxxxx+xkhY.'x*!}#RlkkkYY**xxkk*ik'Ytt+*Litktit*+a+*+x-tkkik*titti**kkF***kwxxwxx**h*ixl xkkkki**kxwwxµkhh'RhxkYY***xxhkk;xh+x}},ykµµlk++*
STATE OF IOWA )
COUNTYOFJOHNSON )
'��Sub cribeds and worn to before me by ti ✓Tali 1 Lt1 own this day of
Fin KELLIC K. TUTTLE
Public in and for lire
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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 Co
de)
Expiration date of Chauffeur's license o� 125 1 L)2 n
7
Signature of F1 Alit Chief or designee
CQ)1
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 BFLOW.
Slonature of C,Ity Clerk or designee
_Zbt
Dat
xxx**I*t*µN4ii t:r•Ky+***k#t}4*M+x*xsiiy#iwiakwkk*hnx*xxkax*##Yk#kx*i**#*k*wxxxxx*t*4#**#AAtY**y"tw**µWWFt+*k##µ44**4*x#3}+*t**x .,4*4****At
Office Use Only
Approved application
DCI report _
State certified driving record
Website update
DiONTAXIMN DGEAPPLMi0 mordadDDC
03/2015
a
DOT
SViART011i It "' �IVVVL^Ji0wadOtgov
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Inquiry Date: 6/30/2015
Name: Attalla, Jalaleldin Rahemtalia
address: 2525 BARTELT RD APT 2A
City/State: IOWA CITY, IA 522462718
Mailing Address! 2.525 BARTELT RD APT 2A
Mailing City/State: IOWA CTIY, IA 522462718
Convictions
FCitation Date
01/28/2014
prose of Driver Services
PO Bax 9204 f Des Moines, IA 50306.9204
Phone, 515-244-9124 1800,532-51211 Fax: 51 =239-lili
wwv.Clawadot.pov
Certified Abstract of Driving Record
Dll S:
459AF2353 (IA)
Customer Or:
5741899
Class:
D
ID Status:
None
Audit tt:
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:
No -ie
Restrictions:
NONE
Restriction
None
Date of Birth:
4/25/1974
Supplement:
Sex:
M
History Information
Conviction Date f.CD Expianatian county JOp
02/06/2014 S92 Speed Johnson IA
Accidents - Accident involvement indicated does NOT mean the Individual was at fault or given a citation.
Accldf,nt Date
- -. - _. Case Number AIR12/08!2013 773179 JA
Name: Attalla, Jalaleldin Rahemtalla ll 459AF2353
Pursuant to Iowa Code §321.10, 1, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby serbfy 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 effice,
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 upor this document, at Ankeny, luwa this date:
Si01i A
te? D. 0.7,;r
�''�4?'�allrti�'•/
hb,a,ne
Name: Abdalla, Jalaleldin Rahemtalla DL/ID: 459AF2353
6/30/2015
Office of Driver Services
Iowa Department of Transportation
F _' w 4 17 rot u�v of Urlfou
I a' rove>t gant No 031 t 1%1
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STATE (Jfi'J()NyA
I— istary Fttvoll(I Check �>
Request Form
i01"o Divi,Fwt U1 Criminal lu A(igalioll
�UpFor"l C1hr-'ra FlOns T3tt rez u, 1'� hlpnr
215 R. 7'^ 5[rcet
Bss M'60, Iowa 503!9
(115) 723-6U56
(515) 715-6080 1'ar
um re vesun an Iowa Crin1lnal l-listotl' Recor
i,asf Name gaardemp9-'��,1i.Sf
1V�
Gam. Iii -7u I Uale
D(II P,ccnuul IJumher, �LL'�.Z -r
Orarrhurnlcj �'—�
hrnnr , C:ky of low ciiy _
City Cfarlrs' Office
4101i.Washin lon5[reot
Iewa CEf{
IA 52246__
Mine: 3]9.356.9042
Fa%: 313-35ti-5497 ��—'�--
a� ns ver tr{/OYhrtt110N: 'Without a sigrcd lvsivel• from the subject o1(he request, E eemplele Criminal history record may not
he releasable, per Cade 0110wa, Chapitr 692.2. Far an IF(e Criminal lilttory 1'eeerd iflroriciatiob as history
by law, al y no
obtain apbtaln w nalwv From fhesuE'em of hcrt nest.
WF71ver%te�gU3'C:Yrwre6 Iva mmsi
Inresli"OD" r7 s 8 trobi,mie .6 It'%( is m2hmfm b ro is JDCI . ibe I timival h1f10rrreby I Ahad wifi rbc i)it'ision of C'riudual
MCI). Any arirnincl Listory dela pavmmring mC 9suf is mab)rainaA by rhe DCI may be releauU w ello�sw by Iary,
Waiver Sign a4u e:
F()�[1 E; 1'FII]IO aii , 1510 i' �6;CU1. Check Result
As of 2; (�, n search Of the provided nelne and dale
of birth revealeas:'
<y
cn-
rrrt
NO lowaCrimimil liistoay Record found will, DCI
Iowa Climirrd FlislO)y Rrrard attached, UCl It
o
DU ini ials
t]C]-77 (08125/1(1) —------._^. --- ----
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—
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Received lima Jufl.3D. 2015 2:52PM No. 1932