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CITY OF IOWA CITY
410 East Washington Street
Iowa City. Iowa 52 240-1 826
(3 19) 356-5040
(319) 356-5497 FAX -
1. Name
2. Mailing Address P n.13ox 2 53 2-
3.
3. Telephone:
4. Prior experience in transportation of passengers:
Authorization Number
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
Middle
Other:
Last
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense
Where
When
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?
Type of Offense
Where
7. Have you been convicted of any traffic offenses in the last five years?
When
Tvoe of offense 7 Where When
RLOr1 I (J t.�IN �li—� 6 r2z j2 c)(.)
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
Type of offense
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) The re-
port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli-
cation.
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
deNta idrivbadg 09/2010
I he certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
f�LZ/f �? I understand that if I falsely answer any questions in this application, that this
application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will
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 a license
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 _ Date 2 �Ss / ( 2
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by f+�t s On this a day of
Ngo an(_P lic in and for the State of Iowa i, n�
*#*IY*#»++*1M1*+*+I+**i+111+1#i1*IIIIMiif111M111M1i*M*IiM**#*I*#f#*##Y#111!11#11f111fiii1+111*+Ili*11***M****##*#*#*##f#1f1111f#f111f1ff1f1ff1f
I have reviewed this application, DCI report, and the State certified 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).
Date
a_8 -ice
Date
After Police Chief and City Clerk have approved authorized taxi driver names will be placed on the city website at icgov.org.
Taxi cab businesses are required to provide Driver Identification cards.
f#HYYMYH#Y#f###YYYYH####Y##############H#########+#YYf1f##Y####YY#YY11fYfflfflflfi4M1f11111111li#fe1N##+H*W#trtr###i#Y###tr+Y#'Y#iY+#f#Y#YY#Yf
Office Use Only
Approved application
DCI report
State certified driving record
Website update
deMmi&vb geappMl0 tl 09/2010
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Iowa Department of Transportation
Office of Driver Services (Tdl Free) OW -532-1121
PQ Box 9204, Des Moines, IA 503D5 -92G4 515-234-9124
FAX: 595-239-1837
Certified Abstract of Driving Record
Inquiry Date:
2/8/2012
Name:
Ahmed, All Omer All
Address:
2401 BARTELT RD APT
Issue Date:
1A
City/State:
IOWA CITY, IA
Date:
522462701
DL/ID #:
248AD4337(IA)
Class:
D
Audit #:
5653967
Issue Date:
11/29/2011
Expiration
09/22/2013
Date:
Endorsements: 3
Mailing Address: 2401 BARTELT RD APT Restrictions: NONE
IA Date of Birth: 9/22/1968
Mailing City/State: IOWA CITY, IA Sex: M
522462701
History Information
Convictions
Customer #: 5409180
ID Status: None
DL Status: VAL
CDL Status: None
CDL Cert None
Status:
CDL Med None
Status:
Restriction None
Supplement:
Citation Date Conviction Date ACD _ Explanation County IUR
10/22/2009 12/15/2009 _ S92 'Speed '52 IA
Name: Ahmed, All Omer All DL/ID: 24BAD4337
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:
......... :vi 4r
2/8/2012
IOWA�?''o,
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D.O.T.'
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Office of Driver Services
'
Iowa Department of Transportation
Name: Ahmed, All Omer All DL/ID: 248AD4337
Fkb, 3. 2012 9:50AM
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Div of Criminal Investigation
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Requegt Form
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DC1.77 (08/25/10)
Received Time Jan.26. 2012 11:43AM No -.7215