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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
First
1. Name
/1\/
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
Middle
ASR1-nt
(Office Use Only)
LF LC III
2. Mailing Address aC10 Bar-jFf CA Ant -u"�C , low C' erI-I. IY4 , 4
3. Telephone: Home
4. Prior experience in transportation of passengers:
Other. l li - r1 O U- g a Y 2-
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? pJ O r
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? r`IO
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 driver's license or chauffeur's license been suspended or revoked in the last five years? KO
Tvoe 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)
Gert idnvba g 09/2010
I hereby certify that 1 have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
r7 Lf ( A 6, 7 _()Ig
I g . 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 etae Date
4}}4Rf4R4YHY##1HkHHHHYHf f#HHR44RH4Hff4f Y4R*te#1`R}H44}H}4ff4f4f }##xf##HRHH4HHH4HHHfe4kH*4fkH}}H44H441k4k#HR}!4}}4if fHH#M
STATE OF IOWA )
COUNTY OF JOHNSON )
and sworn to before me by -n I c,dk ; n )qk d, 1 /q . On this day of
ORT So ��vaGb
Br 159791
Notary Public in and for the State of Iowa
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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).
Signa re of P i Chief or designee
QLCszw
S4n6tuke of City Clerk or designee
-jC__Ja
Date
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.
+++++++++H+r++*H#r+rrrr+rrr+++Hrr+rrr+r+H+H+++++++++HHrrrr++++r+++++++H+rr++H++++H+++H++rr+++++k+++HH+rrH++++rH++HH+++H+rHrr+
Office Use Only
Approved application ✓
DCI report t/
State certified driving record ✓
Website update �—
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osno,o
.Aug. 1.
2012
4:09PM
Div
of Criminal Investigation
No.6698
P. 2.
Ju:•JI•
LUIL
II:4)AIVI
City
Werk — Gity oT lovia Glty
No. 7649
P. 2/2
STATE 03F
�•Record
.�rew4tt -�
Criminal r i o,r, Check
.:; i o m
Toa Xowa Dlvlslon of Crlmina(Inve.9llgadon
Support Operatloaas Bureau, I" Floor
219X 7`h Street
DesMoines,Iowa 50319
(515) 7256066
(515) 725.6000 Fax
DCIAocountNumbar;—TUC)2--17
(Irapplloable)
$ronr. CITY OF IOWA MY
CITY CLERK'S OFFICE
410 E. WASMGTON STIIEET
IOWA CITY IOWA 92240
phone: 319-356-5041
Fart 319356-5497
(DCl use'eniy)
As of I i I« a search of the provided name and date of birth revealed; I ,
eNo Iowa Criminal history Record found witli DCI
Iowa Criminal flistory Record attached, DCI
DCI initials !�J
ieceived Time7Ju1;, j3 It2012 11:.45AM No. 0549
Iowa Department of Transportation
Office (if Driver Services (Toil Free) BOU-532-1121
Pt? Box 9204, Des Moines, [A 503fifr92124 515-244-9124
�4 f0i FAX: 51'x23339-15371837
Inquiry Date:
8/8/2012
Name:
Abdella, Alaaeddin
CDL Cert Status:
Nasreddin Elzaki
Address:
2510 BARTELT RD APT 2C
City/State: IOWA CITY, ]A 522462716
Mailing Address: 2510 BARTELT RD APT 2C
Mailing City/State: IOWA CITY, IA 522462716
Certified Abstract of Driving Record
DL/ID #: 544AG7008 (IA)
Class: D
Audit #: 5636330
Issue Date: 11/17/2011
Expiration Date: 07/31/2016
Endorsements: 3
Restrictions: NONE
Date of Birth: 7/31/1976
Sex: M
History Information
CLEAR DRIVING RECORD
Name: Abdella, Alaaeddin Nasreddln Elzaki DL/ID: 544AG7008
Customer #: 5868048
ID Status: None
DL Status:
VAL
CDL Status:
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 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:
...........
8/8/2012
IOWA6
).0.T.:41
....NEB..
Office of Driver Services
>y� �
Iowa Department of Transportation
Name: Abdella, Alaaeddin Nasreddin Eizaki DL/ID: 544AG7008