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CITY OF IOWA CITY
410 East Washington Street
CI a Cit Iowa 52240-1826
1 356-5040 �I rl (M6,K-
(319)356-5497 FAX
First 11
1. Name i �,i
Authorization Number 19—Y4
(Office U e Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
M i d Middle,, ,, Last 5L51_(Ate (
2. Mailing Address (,`I?Z CoUe�e Park ei .c:edaYRaedS,1k rp2goL(
3. Telephone: Home CH 0 8) H O CI— C1 I l 1 Other:
4. Prior experience in transportation of passengers: Th w e. LieANS e )(f e Y 1211 C e of M y&-Jeol
sery v e e rutY h omavi -
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Tvpe 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?
Type of offense
0
Where
When
When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
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)
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)
dek axidrivbadg 09/2010
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
q 3 A44 Kq o 8 . 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 6 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 ApplicantDate I3 %
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STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by 14 m; d m, F /S(4 v{, On this i i day of
Zµ �'c/D�- SONDRAEFORT
commission Number 159791
Mya�7 �a �r Notary 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).
d"Y /f!/>
Date
iy a&-�io
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.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
d.d .idnvba Wapp2010A 09/2010
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Iowa Department
Office of Drimr Sefvices
PO Box 9204, Des Manes, IA 5031111 4
of Transportation
(Toll Free) 80-532-11221
515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
6/5/2012
DL/ID #:
S98AH4908(IA)
Name:
Elshareif, Hamid Mahmoud
Class:
D
Address:
6722 COLLEGE PARK CT SW
Audit #:
5984908
APT 3
Issue Date:
05/16/2012
City/State:
CEDAR RAPIDS, IA
Expiration Date:
03/13/2017
524047511
Endorsements:
2
Mailing Address:
6722 COLLEGE PARK CI SW
Restrictions:
NONE
APT 3
Date of Birth:
3/13/1971
Mailing City/State: CEDAR RAPIDS, IA
Sex:
M
524047511
History Information
CLEAR DRIVING RECORD
Name: Elshareif, Hamid Mahmoud DL/ID: 598AH4908
Customer #:
5911012
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Med Status: None
Restriction None
Supplement:
^urmant 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:
-
%W
6/5/2012
1V
IOWA.'
).O.T.:�g
�l
r........I
Office of Driver Services
a� PAS
Iowa Department of Transportation
Name: Elshareif, Hamid Mahmoud DL/ID: 598AH4908
-Jun. 13. 2012 12:05PM
Jun. 5, 2012 3:54PM
Div of Criminal Investigation
No.8966
P.
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City Clerk - City of Iowa City
No.2458
P.
2
STATE OF IOWA
Criminal History Record Check
Request Form -
To; Iowa Division of CrIMI lel rnvestigation
Support Operations Onr'000,1'( Floor
215 E. 7'r' Street
DesMohres,Iowa 50319
(515) 725-6066
(515)725-6080 Fax
L,rnu 01,A& 1 nn%
DCI Account Number: I UQDL- ` f
(itapplienblo)
Irromt CITY OTIOWA CITY
CITY CLERK'S OFFICE
4X019, WASHINGTON STIRVET
XOWA CITY XOWA 52240
Phone: 319-356-5041
liaxi 319-3565497
Last Name (menda(ory)
First Name (mmdamy)
Middle Name (rccommrnded)
KGs �aY�
{ami
MCA hA.oad
Date of Birth (n,endato
Geoder (mandatory)
Social Security Number (rawmmoada
-sh L ( H11
Male bFemale
() 6 2- q q -� 'j, 1� 15
Waiver 11dormatioK: Without a signed waiver koro the subjoct of the request, a complete criminal history record may not
be release blo, per Code of Iowa, Chapter 692.2. For complete criminal history record Information, as allowed bylaw, a4yays
uest
obtain a Waii-or sl nature from the sub fect of the request,
WRLVei' Release: f herebygivo pemi(ssion for the above foquming oaloinl to conduct an Iowa edminat Idslory record checkwl(h the DWlsloll aft2rim(nal
imrestlgalloh(()C), pny criminal history dais coneerningmo that islnaintelried by the DClmgyborclluscil as by law.
sa((owncd
Waiver•Sigraature; /1_
Iowa Criminal History Record Check Results (DC;Tooidp)
As of j3h5k a search of the provided name and date of birth rovealed: -
7 _..
No Iowa Criminal Histolry' Record found with DCT '
Iowa Criminal History Record attached, DCT # �`
1)CI
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