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Home My WebLink About17-129 E r IDENTIFICATION NO. 1 (Office Use Only) MK Ill tat AT v. eat mega FAIT APPLICATION FOR TAXICAB 1 MOTORIZED PEDICAB VEHICLE DRIVER CITY O F IOWA CITY (Police Department review must be made between 8 a.m.to 3 p.m., Monday-Friday) 410 East Washington Street Iowa city, Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application (319) 356-5040 (3191 356-5497 FAX First ) MiddleLast 1. Name (REQUIRED) Q(,l S 1� , eko(l L( .�_ C/' 2. Address (REQUIRED) �P 7 / zy7? t r 1 f11-1) r L !/4n l !^f 3. Contact Information(REQUIRED) Email: yo S(�,- 7 y,t zy'2 , LCr's Cell Phone: 70 6-z 9 Li CP f Q$ (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 0 f ? \ � ' 2 b. Taxicab Business Name(REQUIRED ' r C • b TgAl 5. Prior experience in transportation of passengers: , '( i 6. Have you ever been arrested I charged with any misdemeanors and/or felonies in this State or elsewhere? f0-) 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? r Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty: ._,Oti} 8. Has your driver's license or chauffeur's license been suspended or revoked in the last fivert? .77 J/`)�'��+ � 3—: � r mar..•. Type of offense Where - alltfhen�- 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 2-7 PA/ issued on 5-/3307- expiring on 01/0/1?_D 2Sj' . 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.Titte-57Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant / � Date c05// STATE OF IOWA ) COUNTY OF JOHNSON ) Subscrib and sworn to before me by Yi„ut-v‘T r . Al4c0clem Duk'f on this /EI day of %1' l *ENV t MAYER ' - - No ary Public in .1. for the State of I., - I. 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 Driver's license 1 /2C222 i a ut re of Po ice Chief or designee g 9 1X52-°17 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. O m Sign ture of City Clerk or signee D -- C)—: r- ";`r-r.- mm ****#*****##******#*************#******** #*##**#*************#******#****#************** Office Use Only Approved application DCI report State certified driving record Website update aenk/rnwDRiveAocEAwPL92014a oeo.00c 07/2016 Page 1 of 2 lOWADOT I SMARTER I SIMPLER I CUSTOMER DRIVEN wWvv.iowadogov Office of Driver Services PO Box 9204 I Des Moines,IA 50306-9204 Phone:515-244-9124 1800-532-1121 I Fax:515-239-1837 www.iowadot_goy Certified Abstract of Driving Record Inquiry 9/15/2017 DL/ID#: 210AN5857 (IA) CDL Permit Class: None Date: Customer 6676382 Class: D CDL Permit Issue None #: Date: Name: Abdalla Omer, Yousif Audit#: 2105981 CDL Permit None Fadlalse d Expiration Date: Address: 2604 BA TELT RD APT Issue Date: 08/30/2017 CDL Permit None 2A Endorsements: Expiration 01/01/2025 CDL Permit None Date: Restrictions: City/State: IOWA CITY, IA Endorsements: Chauffeur 2 ID Status: None 522462728 Mailing 2604 BARTELT RD APT Restrictions: NONE DL Status: VAL Address: 2A Restriction None CDL Status: None Mailing IOWA CITY, IA Supplement: CDL Permit ELG City/State: 522462728 Status: Date of 1/1/197 CDL Cert Status: None Birth: Sex: M CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Abdalla Omer,Yousif Fadlalseed DL/ID: 210AN5857 (IA) Pursuant to Iowa CodeI§321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Department of Xr nsportatlon, do hereby certify that I arra the custodian of the records held by the Office of Driver Services, that this is a true artill:/accurate copy of an official record currently in the custody of said office, and that I have been authorized by the Director f the Iews Department of Transportation to so certify. In witness whereof, I Nave caused my signature and the seal of the Department to be set upon this' r rner� iyr,t AnkwIowa this date: --I C) Ant :<lr -t M 0 ,10.•''' ''''%/4. s 9/15/2017 /g: IOWA str 1171146ey,")Opieede, '�y MD. O. T.lei Irrr4t i Office of Driver Services Iowa Department of Transportation Name:Abdalla Omer,Vousif Fadlalseed DL/ID: 210AN5857(IA) 9/15/2017 Sep. 14, 2017 12:08PM Div of Criminal Investigation No. 1012 P. 6/8 .From:t�rry or rowel C;iry Clark Ltrrrca ala 36664607 09/11/2D17 16:te 0220 P.002/002 • • `_,�,?,. ,` i,. STATE F IOWA � maca • t ,4riltilciftay RecordCheck Do ci Account Number: LI W '1— (717p/3licahit) --- To:. Im;'u Division of Criminal investigation From: City of lows Cit Support Operations Bureau, IF'Fluor m City C:tC.rkss Office215 E.7 Street 410 E.Washfn};ton Street Des Moines,Iowa 5031.9 �� -- -•—w__• -- (515)725-6066 Inks CD.t .230 - (515)723-6050 Fax — IA 47 — -- Phone7 319-356-5041_ l+aa; 319-356-5497 -I ana requesting an Iowa Criminal Hisi cry Record Check on: Last Name (mandatory) First Name (mandatory) (ddhe Name(recommended) ilb(Peta‘' v (9-n9v.lr you5ir 1----GO 2.):l ee (.S-19-51—e_A Rate of I3irth1(rnandatory) Gender(mandatory) Social Security Number(recommended) L9 \ 1 a \ Ulla_ Rale °Female 6-17 / ( 0 •-; 7 q-5 Waiver information: Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable, per Code of lows,Chapter 692.1.Icor complete criminal history record information,as allowed by law,always _obtain a waiver signature from the sub Ect ofthe request. Waiver Relensa-t hPrr>, iYa-0emrission-topthe.ahewG�gq tins-ollicialto- rim nducrorva utntinallu o�ryiecord check wnlr the Diviti r---li a Investigation(DCI). My criminal Norm.(Wit rnnr filar,ar;rA.r..........1 k,, r`01.....1.1,- .11.11v....1„ .... II),,,r. f liminal cn �'rtiverSianature; ( r?-1 *.:.....,,.: Iowa Criminal 13istory Record Check Results ` -.� -; Pit use AL- As n� As of__- l�-�7, a search of the provided name and date of birth revealed: .. � . No Iowa Criminal History Record found with DO 0 Iowa Criminal history Record attached,DCI 1 - DCI initials , CC;_, L DCI.-77(08/25/10) Received Time Sep. 11. 2017 2:53PM No. 6522