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CITY OF IOWA CITY
410 East Washington Street
Iowa City. Iowa 52240-182fy, Ig
9) CITT_356-5040 -(
(3 19) 356-5497 FAX
Authorization Number /'C ✓n)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday - Friday.)
(Office Use Only)
First Middle Last
1. Name ✓VI U M A-e7Rl X 1 A f3o G G14 V
2. Mailing Address 2 4 o V-+eG eq rf 2c S a —f— C -i r- 5 7I6�
3. Telephone: Home 9) 01 b9I1 1 0 Other: 3 (Cl So -L-
4.
4. Prior experience in transportation of passengers: V;, Ye " -�
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense
Where
When
/V O
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? JO
Type of Offense
Where
7. Have you been convicted of any traffic offenses in the last five years?
IV 0
When
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? O
Type of 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)
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DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND ST
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)
darRn�a�caey 09/2010
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
N 1 8 1C i S g 3 Z . 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 ApplicantyC' Date 2 1.2 /Z
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STATE OF IOWA )
COUNTY OF JOHNSON )
ri ed and sworn to before me by
_)_0 IQ,
,9Nt . KELLIE
tlC SSG1 On this 2-a day of
Public in and for the State of Iowa
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).
17 ��
Date
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.
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Office Use Only
Approved application
DCI report
State certified driving record
Website update
clan anwldg#apP2010,d 09/2010
Fero. 9. 2012 4:32PM
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11Div of Criminal Investigation
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)" NO Tows Crhninal Idiseory Record found with DCx
Q Towey G` r9minaI.idistorgRecord attached, DCl:
Mfiniifels 4�e_
deceived Time Feb. 2. 2012 3:29PM No -.8005
Iowa Department of Transportation
Office of Driver Services ffoll Free) 8041-532-1121
PO Box 9204, Des Maines, lA 50305-9204 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
2/2/2012
DL/ID #:
428XX5832(IA)
Name:
Abo Elhassan, Muna
Class:
D
Restriction
Magribl Mand
Supplement:
Iowa Department of Transportation
Address:
2608 BARTELT RD APT
Audit #:
4752474
2C
Issue Date:
10/15/2010
City/State:
IOWA CITY, IA
Expiration
01/01/2014
522462730
Date:
Endorsements:
3
Mailing Address:
2608 BARTELT RD APT
Restrictions:
NONE
2C
Date of Birth:
1/1/1974
Mailing City/State: IOWA CITY, IA
Sex:
F
522462730
History Information
CLEAR DRIVING RECORD
Name: Aho Elhassan, Muna Magribi Mand DL/ID: 428XX5832
Customer #: 222610
ID Status: None
DL Status: VAL
CDL Status: None
CDL Cert
None
Status:
CDL Med
None
Status:
Restriction
None
Supplement:
Iowa Department of Transportation
Pursuant to Iowa Code §321.10, 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 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:
'•'�",
2/2/2012
IOWA
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Office of Driver Services
Iowa Department of Transportation
Name: Abo Elhassan, Muna Magribl Mand DL/ID: 428XX5832