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Home My WebLink About12-154Y Authorization Number \�— ksc% l t (Office Use Only) APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (Police Department review must be made 410 East Washington Street between 8 a.m. to 3 p.m., Monday – Friday.) Iowa City, Iowa 52240-1826 Io I9) 356_5040 (319) 356-5497 FAX 1. Name /'I/f/4:2rye 4d4lhteIdiil 'a1-4da at q 2. Mailing Address o7 111VWP �J d tt 11 /414A� t , 1y4C Z -2 U; p 3. Telephone: Home / Other: TC _ C- -3 :w % 7 4. Prior experience in transportation of passengers: ��X f�r / y 1 -ll r 01—; a C f,il--y 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?yL Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? AZO Tvpe of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ill L) Tvpe 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) cher / idrlvb g 09/2010 I hereby certify that I have 'ssued to me by the Iowa Department of Transportation a valid Chauffeur's license number y 3 f} F1 �1 . 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 Date9.Z STATE OF IOWA ) COUNTY OF JOHNSON v {.h Subscribed and sworn to before me by m 4 ; A�r 'VZi On this day of in and for 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). Ak�� Signature Police Chief or designee Sig re of City Clerk or designee Date �'-7-ice 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. R**fRMffMMfMMM#MM#MMMi#!####!4#******f*****RR*!f**M4RffM**MRMM#f f Mf*flMfflifMMMMfRMfMRMMRMM#M#MM##M##Yr#**#*;***! Office Use Only Approved application DCI report State certified driving record Website update der .dnW dgeeWMIOd 09/2010 ARTS Page 1 of 1 Iowa Department of Transportation Office of Dryer Services (roll Free) 800-532-1121 PO Baa 9204, Des Manes, IA 503Dii-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 7/31/2012 DL/ID #: 473AF1848 (IA) Customer #: 5751443 `name: Abdelrazig, Maisara Class: D ID Status: None Mohleldln Address: 1102 HOLLYWOOD Audit #: 4743066 DL Status: VAL BLVD APT 11 Issue Date: 10/13/2010 CDL Status: None City/State: IOWA CITY, IA Expiration 10/07/2012 CDL Cert None 522407046 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 1102 HOLLYWOOD Restrictions: NONE Restriction None BLVD APT 11 Date of Birth: 11/1/1972 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522407046 History Information CLEAR DRIVING RECORD Name: Abdelrazlg, Malsara Mohieldin DL/ID: 473AF1848 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: ?r...... /d;44 7/31/2012 IOWA :tea D. 0. T.;- =441V r Office of Driver Services Iowa Department of Transportation Name: Abdelrazlg, Maisara Mohieldin DL/ID: 473AF1848 7/31/2012 Aug" 6. 2012 2:40PM Div of Criminal Investigation . w6. I. LVIL Y. VU e1 l.ity bl:r8 — blry el 10 W t.l t iV o. 7391 PP.P. X3/4 STATE OF IOWA Crimixialffistory Record Checkt RequestForm Fi •'•�'�� DCI Account To: %wn Division of Cr•1nr11tal lnvesllgation Support Oporatlons Bureau, V Floor 215 E. 7,h 9tvant Des Moines, Iowa 50319 (515)725-6066 (515)725-6080 Pay \qk: I am requesting an Iowa Criminal History Record Cheek on: From: CITY OF IOWA CITY CITY CLFIws OFFICE 410 F. WASIITXGTONSTRI;L+T CITY IOWA 52240 Phone; 319-356-6041 Fax: 319-356-5497 Last NAIRe (nmodatory) I Myst Name mnnd&tory) Middle Name rocommended) ,MorG M 2 r c7 Ohl s 4�< A "o yi Date ofEi/rth (nimmo Gender (mandat Social Securl Number (recommerme t7rn Male ❑Female 6 I3 5� �( 6 y IWaimrinfoimalion:' Without asigaedwa(vevfromthesubjectoftherequest,acotaplotoorllninalhistolyrecordmaynot be releasable, per Code of Iowa, Chapter 692.2. For corn lets erlminalhistory record Information, es allolved by InrY, all, obtain a waiver sh!nntare from the sub loot of the renuest. WalbeY $eiea,Vet IltcrAy sivo ponnission for rtto above lnvestlgallon (ACQ. Any «iminol bistorydale wnceminy me s WitivelrSlrgnalure: to conduct an Iowa erlminal hhtro y record check -Ad ih lite DNlslOn otCrlminal V t"C1 may be rcf:&sed as allowed bylaw. Iowa Criminal History Record Check Regults As of 0 b �d a search of the provided name and date oPbilth I'ovealed: tA No Iowa Criminal HistolyRecordfound withDCI ❑ Iowa Criminal History.Rccord attached, DCI DCI initial Received 7ime7'Aug. 1.[(2012 4:02PM kl0.6677 (Muse only) L� N mo CA'Tl G-) 1 t7rn 62) A D � N o