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Home My WebLink About12-163S r 1 CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 C(3:196-5040 (319) 356-5497 FAX 1. Name 2. Mailing Authorization Number (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday – Friday.) Firs Middle Last Ag nu"��f:_�,�M�?�I A" M N,,o 14114 Addressan'xW� —r fit t�_gPr 14 jr-,LJ C " 3. Telephone: Home 91�9 - gz; I - Q- I— 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? N U 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? Al/) Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? N O Type of offense Where When B. Has your drivers license or chauffeurs license been suspended or revoked in the last five years? �% D 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) ded idrivbadg 09/2010 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number Gd C r q $ !lD . 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 Date o'dlo��,7o/Q ##RRf 1f111f1Hf4#YYY#4HYH###fefifflflHHH#YY#YYYY4HR11##R4kfHtf k1f1M11fHH1HHfflhl4#Y#4#f 4#####HH#R#R#+#t1f1f1Hff141#f4Y444H#R#*##4 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by U in and for the'State On this to day of 1i C X13 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). Sign2ture of Polll5e C& or designee 2h�/ Sign re of City Clerk or designee /3 e ate 3'/3 —/a - 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. *++*f**Ht4f f*H;Hf#11f f##k##}-f*H;44f4itf 11N4Hff#-k##f+f+i+i####t##*tf *ff #;*f f H1f;;1HHHHf;1111#Yf*f+f4##44 Y!#**##**#*tfetf11H4f1f 11f ##4f Office Use Only Approved application DCI report State certified driving record Website update deck idnvbaJge 2010.tl 09/2010 CA Iowa Department of Transportation Office of Driver Services (Toll Free) 1 -532-1121 PO Box 9204, Des Moines, IA 503f)(1-92114 515-244-9124 FAX: 515-239-1837 Inquiry Date: 8/3/2012 Name: Abdelrazig, Abdel Rahman Mohamed Address: 2411 BARTELT RD APT IA City/State: IOWA CITY, IA 522462706 Mailing Address: 2411 BARTELT RD APT IA .'.filing City/State: IOWA CITY, IA 522462706 Convictions Certified Abstract of Driving Record DL/ID rt: 214CC9840 (IA) Class: D Audit R: 5857819 Issue Date: 03/14/2012 Expiration Date: 01/01/2015 Endorsements: 3 Restrictions: NONE Date of Birth: 1/1/1956 Sex: M History Information Customer #: 4313828 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Office of Driver Services Citation Date Conviction Date ACD Explanation County SUR 12/23/2011 01/03/2012 S92 .Speed 52 IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number IUR 10/14/2011 653163 IA Name: Abdelrazig, Abdel Rahman Mohamed DL/ID: 214CC9840 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: •.�;v/4� 8/3/2012 IOWA ). 0. T.:: . ...... Office of Driver Services Iowa Department of Transportation Name: Abdelrazig, Abdel Rahman Mohamed DL/ID: 214CC9840 Aug. 9. 2012 4:20PM r ,Aug. 3. 2012 4:17PM Div of Criminal Investigation City Clerk - City of lova City STATE OF YOWA Criminal History Record Check Request Form To: Iowa DIvlslon of Crlminal investigatlon Support Operatlons Bureau, V Floor 215 iv. 7'4 Street Des Moines, Iowa 50319 (515)112,5.606K (515)125.60ho Fay: 7 an, , Annachinn on Tnwa rMrninal T kfniw R ernrel Chnrle on: No.8240 P. 29/30 No. 2670 P. 2 DCI Account Numb&: "I-ooX- C= (f apQOenbie) From: CYTS( OFIOWA CITY CYTY CY,ERTC's OFFICE 410)9, WASEINCrTON STRIdET IOWA CITY IOWA 52240 phone: 319'356-5041 Fox; 319356-5497 .Last Namemnndnlo) k7.1•st Name(lmandatory) Middle l�allle (reeommcndc sire-z� e d4eC bd�Lw��w)ah M4im�ri( Date of Birth (mandatary) Gender (mandatory) SOCial security Number (recommonded r xr —n D 6 �Vlala �bamale 360 2�0 Waiver-Tmformadon. Without a slgned waiver from the subject of Clio request, a complete criminal history record may not be relepsable, per Code oflows, Chapter 6922. For com lets criminal h [story record Informntlon, as ailoWed bylaw, always obtain a Waiver signature from the subject ofthe request. Waiver.Relense:Ifimbyglvopemilssionfor the above regorstrngofrtcinlIownduaaliowncsimjnalhjsloryscwrdchec %Yjffi ibeDivisionofCriminal Invesilgellon(DCI). Any udroindldslory data renarriagnio Ma[Ismalmabied by iho )7Clmnybemlenscd as ellawed bylaw. Waiveiv Signature: Va Iowa Criminal ktory Record Check Res1Iitg As of D --( C—1 I , a search of the provided name and date of birth rcveale4 ''F°'-. No Iowa Criminal Histoty Record found with DCT El Iowa Criminal Ilistoxylteooxd attached, DCI DCI �CTuIteJLn(y) r-tr 7 r xr —n cn �. 1, r� w D