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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(3 19) 356-5497 FAX
1. Name
Authorization Number /9 — / �Lk
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday - Friday.)
Middle
Last
(Office Use Only)
2. Mailing Address Sc.eYi f S t /o wa U f / /A -z_2240
3. Telephone: Home 917_ SW''- 2.6,#6 Other:
4. Prior experience in transportation of passengers:
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 When
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where When
8. Has your drivel'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)
/ty
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)
clerk/IaxitlrivCatlg Q9}ZQ�{)
�b12o1�
I hereby certify that I hav i sued to me by the Iowa Department of Transportation a valid Chauffeur's license number
g� /%_�i 1 understand that if I falsely answer any questions in this application, that this
applica`tio'n 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 9- 3-/2
##+iH#t++tti##Y###Yi#4#tr44##4f#trf#f#Y##########f##YY###+####YYf#f#flfH4#flfM#Nf##1f14Yf1ffffl!#f#ffifi#f1#Mf1fMf#f4#Yt*tf#f#lfiffif1ff44#f
STATE OF IOWA )
COUNTY OF JOHNSON )
scribed and sworn to before m e by &QM71L I t IOY 64-r11(�-O( On this day of
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).
c /a
Signatu of Pol a hief or designee Date
Signat ity Clerk or designee Date
NOT VALID UNTIL Police Chief 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.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
clerlvtax&NtadWaW2010.tloc ( A
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Jul.30. 2012 1:44PM Div of Criminal Investigation
Jo14t7. Lu12 1:13rM t,tty 6100 — blly or Iowa UIty
IOWA
Sjrmv,ti.Criminal HistoryRecord Check
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rm
I)CIAn
n ,
To: Iowa Dlvolon of Criminal rnvestigation
Support: Operations Iinreau, r'Floor
219t, 7tl' Street
Das Moines, roWa 50319
(519)126-6066
(519)125 -colo Fax
I am requesting an Iowa Criminal iiistotyRecord Cheek on;
@o.a 611 r. 3
Tram; CITY OF IOWA CITY
CITY CTIER IS oi:r:rcrr
410A WASHINGTON STIMAT
IOWA CITY IOWA 52240
Phones 319-356-5041
VAX., 319-3564497
Last Name andston)
I First Name (.nondalory)
.Middle Name (nmcommmded)
A
,G/o4% Wvw feel
Z'
Date of birth mandalory)
Gendor (mandatory)
Social Security Number remm,,,q,ded
03, j�-/�dL�
1 rale OFeatale
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WailrerYltfol'IlillibU. Without a signed waiver from the subject of the request, a complete criminal history recor d may tint
bereleasable,pevCudooflaiva,Cliapter692.2.lrorpoinjilefe criminal bfstory record Information, as allowed bylaw, always
Waiver.Releas'e; Ihcrebyglvo pemiission fordte abomyequestingofnolal to conduct an Iowa criminal hletorymoord chukwith thoDlvision ofCriminel
rnvestigalion(DCI), Any q1m41101 history daLs wnocmingnso that is mnhefiled by thoDCL may he released Ag allowed by latK
Wa!Vgl' S'igNttLgre;
�.u»4�71;A1.A1 AJUO LVAV JX"Ul LL V11GLiri 1\G3 UA" (DClusoonly)
As of k / ' ,a search ofthe provided name and date of birth re'irealed;
Wo Iowa Criminal history Record round with DCI
Iowa Criminal history Record attached, DCI #
DO initials
Roeoivo n� Tinn7�li1��3 F�'11111 i•ilPM M. AIAA
Iowa Department of Transportation
Office of Driver Services (Coil Free) 800-532-1121
PO Box 9204, Des Manes, IA 50306-9204 515-244-9124
FN(: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
7/25/2012
DL/ID #:
609AH2996 (IA)
Customer #:
5989009
Name:
Hamza, Mohammed
Class:
C
ID Status:
None
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Zalelabdan
Address:
1516 CRESCENT ST
Audit #:
6092996
DL Status:
VAL
Issue Date:
07/03/2012
CDL Status:
None
City/State:
IOWA CIN, IA
Expiration
03/14/2017
CDL Cert
None
522402137
Date:
Status:
Endorsements:
NONE
CDL Med
None
Status:
Mailing Address:
1516 CRESCENT ST
Restrictions:
NONE
Restriction
None
Date of Birth:
3/14/1984
Supplement:
Mailing City/State:
IOWA CITY, IA
Sex:
M
522402137
History Information
CLEAR DRIVING RECORD
Name: Hamza, Mohammed Zalelabdan DL/ID: 609AH2996
Pursuant to Iowa Cade §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:
:.•"... 4��
7/25/2012
IOWA 'ty
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D. 0. T.;
fSRI S�=
Office of Driver Services
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Iowa Department of Transportation
Name: Hamza, Mohammed Zalelabdan DL/ID: 609AH2996