HomeMy WebLinkAbout16-153®.
CITY OF IOWA CITY
410 East Washington Strcet
Iowa City, Iowa 52210-1826
(3 19) 356-5040
Q 19) 356-5497 FAX
IDENTIFICATION NO. 16
(Office Use Only)
APPLICATION FOR TAXICAB I MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday)
Failure to complete the "required" information will result in denial of the application
First Middle Last ,
1. Name (REQUIRED) t9 KI.4 n Al Q yo I r 1
2. Address (REQUIRED)9X10 R R k r€ iT PE) Ml i n f o tw/A C' Y IA C 2!7 u 6
3. Contact Information (REQUIRED) Emai1:aYvioy-7eIhi,Aaj `uY,L,00,c �Cell Phone:` 0-4.00-;921,,�
(All written communication sent via email)
4a. Driver's License expiration date (REQUIRED) I ye,( Q
b. Taxicab Business Name (REQUIRED) _ C 1 Cd b 1(� �rt/cw c j } -
5. Prior experience in transportation of passengers:
6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhee?;
Type of offense Where When
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty Other nz
o
7. Have you been arrested / charged with any traffic offenses in the last five years? I\" d
Type of offense Where When
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty Other AZ
c
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 4�/
Type of offense V+l here 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)
07/2016
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number
8_L+q,Akg1gk issued ono3/lo/9(1Ij expiring on 119 116 . 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_ fir_— Date
4�
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by
�oausi aulb.
i
�o vSw-- on this S day of
and for tl
x+w+++++wwwwwwwwzzxxxxzxxz+++xw+w+wwwwww+xxzxxxxxx:xx+++wwwwwwwwwxxxzzzxxx+wwxw+wwzwwwwwwxxxxxx+x+x++wwwww:rw+wwzzxzx+x+wwwwwwwwww+www+zxzxxx++ww
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).
Expiratio da of D e s license
Signatur` Police Chief or designee 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.
Signa re of City Clerk or designee
Date
+wzwzwwzxxxxxxzx++++wzzxxwxwwwwzxxxxxxxzxxxxz++w+z+w+z.e++zzxxxxxz+++++xewxz+++xzzzzxxxzxzx+x++++++z+z.x+++xxxxxx+++++zx++++++++ww:zzx++++zxxzwz+
Office Use Only
Approved application
DCI report
State certified driving record
Website update
ae,u7ariDRivenoce PPLe2014amended o C 07/2016
Hu g. IU. 2 u i b i:jiriviI Div of Criminal Investigation No. 0231 P 1!4
Fram;Crly of Iowa Clry Clerk office 319 3�e S494 09/09/2016 10:63 0SIS P.002/OD2
0 &ffA E OF IOWA
crilririaf History Record Check
TO: Ilrvn Division of Cnrinih-W Juvestigalion
uupport Operations TDreou, I" Floor
215 E, 7" Street
nes Moiues, Iowa 50319
(515) 725.6066
(515)725-60&0 Fax
I ant reauestinr an Iowa Criminal kistmv Record Check nw
DCI Aceounf Number:��_
(ifnp,dicahlc)
From: _Cityof[owaCif
City CIerles Office
410 E. Washhtp�t6n Street
Yewa City, IA 52240
Phase: 319-356-5041
Fax.. 319-356.5497
Last Name poandatog9 _ First Name (mwr
anaay) Middle Name (recaannenaed)
ro �S i F N Yw Fi i
Date of Birth Onandelol) Gender (mandelo Social Securi Namber (racommcndd)
n �o3 / 19 7
(Male ❑Female
Waiver Itif0i' eatiafl., 'Without a signed waiver from the subject orthe request, a complete crimbrial hislory record may not
be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record information, as allowed by law, 2hv&ys
oblain a waiver signature from the sebect of fhc reg9esL
µ
Waiver Release: I hereby give permission for the above fegncsling ofrcial to conduct an Iowa criminal history record check %vlb the Division of Criminal
Investigation (DCI). Any criminal history data concerning me that ismainlained by the DCI may be released as alloe•ed by lair.
Wai1rei- Signature:- ^ ��
7—fovea CriminaP istor r Record Check Results
-
(uci use only)
As of _ a search of the provided name and date of birth retreated;
;.
--
-
I
J -
No fovea Criminal lfistory Record found with DCI
® Iowa Criminal HiStory Record attached, DC) 4—
---
DCi initials_..__
DCI -77 (08/25/10)
Rnroiuotl Tima Ano 0 9016 IA,IAAM hln 1005
,ii
L®OT
www.iowadot.gov
SMARTER I SIMPLER I CUSTOM -E MVEN..,. ..
Inquiry
Date:
Customer
4:
Name:
Address
8/10/2016
6271487
Office of Driver Services
PO Box 9204 i Des Moines, IA 50306-9204
Phone_ 515-244-9124 i 800-532-1121 1 Fax_ 515-239-1837
w, v.'. mvladot. jov
Certified Abstract of Driving Record
DL/ID #: 842AK9198(IA) CDL Permit Class: None
Class: D
Yousif, Ayman Abdelhafiz Audit ##: 1216528
Shin
2510 BARTELT RD APT Issue Date: 08/10/2016
ID
City/State: IOWA CITY, IA
522462716
Mailing 2510 BARTELT RD APT
Address: ID
Mailing IOWA CITY, IA
City/State: 522462716
Date of 6/3/1972
Birth:
Sex: M
Expiration 06/03/2022
Date:
Endorsements: 3
CDL Permit Issue None
Date:
CDL Permit
None
Expiration Date:
Restriction None
CDL Permit
None
Endorsements:
CDL Permit
CDL Permit
None
Restrictions:
ID Status:
None
Restrictions: NONE
DL Status:
VAL
Restriction None
CDL Status:
None
Supplement:
CDL Permit
ELG
Status:
CDL Cert Status:
None
CDL Med Status:
None
History Information
CLEAR DRIVING RECORD
Name: Yousif, Ayman Abdelhafiz Elhin DL/ID: 842AK9198
Pursuant to Iowa Code §321.10, I, Melissa Spiegel, 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:
...... �4rr
8/10/2016
IOWA
D. 0. T.
I
iy UC
:@3
Pt
of Driver Services
dRIYFO;9FOffice
Iowa Department of Transportation
Name: Yousif, Ayman Abdelhafiz Elhin DL/ID: 842AK9198