HomeMy WebLinkAbout12-132-4
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VIII
CITY OF IOWA CITY
410 East Washington Street
Iowa ' a S2240-1126
I ) 356-504 q115
(319) 356-5497 FAX
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
II -13Z
(Office Use Only)
First Middle Last
1. Name � O.g� r rt%n/A�) A 8DA 1 L4
2. Mailing Address o RI v D
3. Telephone: Home �I 9_ :3q -l— 3 o o 1 Other:
4. Prior experience in transportation of passengers: is—, V Oj c
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? ►.lo
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?1,1 g
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? 0
Tvpe of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? `.i 0
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)
t.l O
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR PO CE CHI_EF_RtVflEW—
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)
derwtealdnvba g 06/2012
I herebyy certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license nuthber
i �1 A E i4 83 . 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 yj� f Date 9 f 'A I ao ( a
STATE OF IOWA )
COUNTY OF JOHNSON )
Sscribed d syuprn t,Q before me by / —. Own this day of
�40l . TTLE L� I I L
,.Ai �, - KELLIE VK
I' CommCsions ober 221819
j --N tary 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).
/9 a 7 -la
of Policroief or esignee Date
of City Clerk or designee Date
NOT VALID UNTIL Police Chief and City Clerk have approved and authorized taxi driver names 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
cleMtaxidnWadg appMl0. do 06/2012
I
Sep.20. 2012 2:19PM Div of Criminal Investigation No.5405 P. 2
S,tp, 5. 2012 4:27PM Cily Clerk - City of Iowa City No -2807 P. 2
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Support OperaffonCauronu, I'Mor
213 D'. 7i4 areot
X)OMpinos,TONYn 50219
(515) 725.6066
(5x5)125,-6090 Nn%
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CITY CLEM19 OVICE
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TOY.YA CUM lift 52240
Phone, 419--35 —5n41
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i' Yadyg5plYtformatlo7t7 Without a signed *Yc alwer 11•om the subject of the repeat, a eornplolo o1•Pvninpl ll [story record n,ny not
.bb ro]Onsnbie�per Code efXolyn,Chaptcr692.24IrOrrom Iota'cllnl(nalbieto)yrccordlnfoxmntlou,asnllaYiedbyfpWi,pjWnys
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YnYasFfgnt,on (DCn, .any orinl(nal hlslolydaf0. eonwmfng )Ilo IAn[ Ta lna(mnlned 6y lha DOtmey bo re(cased'eS allowed Eyla1V.
+,v .. ,a v�i.a4r�,us.w,tu a.va Y h4vW Nf_W `VA��4A\.4,O,NJ 11{C� µ. .y 0Only)
q "� , a search o£theproVlc%d name t�i9d dato of bia1191ovealed;
sc�_ ��' . �ij
No Iowa Ci-,mihd9jstexykecord found with D cl M (
❑ rDwa G' rimmalflistor7R000rd attached, I)01-#
DC1.' IUiPials� __
Q.—:,,.A T:— Q.., G 91119 A.11Df,1 1,1. 170
Iowa Department of Transportation
Office of ®river Services (Toll Free) 8DO-532-1121
PO Box 9204, ®es MD nes, IA 503E1fi 92x4 519-244-824
FAX: 515-239-1837
Inquiry Date: 9/18/2012
Name: Abdalla, Yaslr Awad
Address: 1900 HOLLYWOOD BLVD
City/State: IOWA CITY, IA 522405926
Mailing Address: 1900 HOLLYWOOD BLVD
Mailing City/State: IOWA CITY, IA 522405926
Flame: Abdalla, Yaslr Awad DL/ID: 367AE1983
Certified Abstract of Driving Record
DL/ID #: 367AE1983(IA)
Class: D
Audit #: 5923031
Issue Date: 04/14/2012
Expiration Date: 02/06/2014
Endorsements: 3
Restrictions: NONE
Date of Birth: 2/6/1970
Sex: M
History Information
CLEAR DRIVING RECORD
Customer #:
5544241
ID Status:
None
DL Status:
VAL
CDL States:
None
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
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 custoillan 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:
Name: Abdalla, Yasir Awad DL/ID: 367AE1983
9/18/2012
IOWA 'y1,
r^••••' $`�@=
flflIVEN,==
Office of Driver Services
Iowa Department of Transportation
Name: Abdalla, Yasir Awad DL/ID: 367AE1983