HomeMy WebLinkAbout12-175CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(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.)
lrst 1 Middle 11 Last J
1. Name ;A1, 4 N� yt GtMGIGU
2. Mailing Address L,\,obeXTc R,d. -t6 2 L
3. Telephone: Home 31g —,6.2 I R 5S -q, 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?
Tvpe of offense
Where
When
(Office Use Only)
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?
Tvpe of Offense
i
Where
7. Have you been convicted of any traffic offenses in the last five years?
Tvpe of offense
Where
When
When
8. Has your driver's license or chauffeurs 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)
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)
denOd idriv adg 06/2012
F
I hereby certif�yy that I hav issu d to me by the Iowa Department of Transportation a valid Chauffeurs license number
44 - ACS 2 S . 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 r/ Date
STATE OF IOWA )
COUNTY OF JOHNSON )
SVscribed and sworn to before me by Sic to mound �qYn; K wM 4 �. On this day of
si -RotZ Q
Mbtary Pu 'c in and for th'e State of Iowa—'? 13 )14
***#**#k4k4kki44Y!*YYkk*#k*R4f*tikfl4lkY***R**#k*414#f441R!*Y*******k*44*tifii4li414Y*!k*k******i4R44*444ff4*NY*#**k**kk4#*44}4*!***R}*R}}#k4#4
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).
Signature olice /'/for esiiggnee
Signaftire of City Clerk or designee
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.
ff###;*f*llffif#f'k'###+#+***f11f#fk4#*4+#***1#f11ff1f##fl*#***R*#*f1fMf11M11f#f*1#*##+**;*Y*1f#1fif1f4Hf#44#*4#****l111l1l111#y.,Y**lff+llfffT#+
Approved application
DCI report
State certified driving record
Website update
deiWlaridiMadgeappM o d
Office Use Only
06/2012
Jul. 3,
2012
2:59PM
Div
of Criminal Investigation
No.1865
P.
P.
1/2
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1STATE OF IOWA
Criminal 0r ' r r o
Request Vorm
Tol XONVADR4110nofCrlmmalTm'natlg tfoh
Suppar80potaltohsAmean, );"VIU01,
Des Molrros, Xon'a 90519
(615) 725.6066
(515) 725-6600 Xrax
Talnra uos(lu an%1va.Crlm)nR1Rfsfo Record
LastNamB (menda(ary) First]
DCTAccountNwnber: 4460�
(IPrppllooEfc}
.Iir•ola: MY OFIOWA CITY
CITY CLLRX's 0ie1?XCI''r
410 D, WAM NOTON STAUT
XOWA CITY IOWA, 52240
p6oao) 919-396MI
XfaY; 3x9-356.5447
IOC"Ad I w 11'609 I /" t I
') d'' 2 �� �9 (Male ❑?emale'� $ �f ��%
WRiver,reo1'Jrlat1on. W11Tlout a signadWAVol' 1rox thosllhject of 1ha regunt, a cornpfoto orlDdtint historyrecord Wray not
T)oraTsasable, per Codeofl'ow&,Chapter 6971.2.Xeor ) oeerlminalhlstotyrcm'tTlnformaifotrra9ailoSfeahyla�V,pTwhyS
.Y.. 1. -. .. _
WRlV81',RaleR'd'd;1
lnvosllgellon (W), Any
eondeeran 1nn'A ethhlnnl hfsteryrererd alukvdlh Ifie o(o fsfoo ofCllmfni
lob Clnleybe refeesed as allowed bylew.
iv_IFH \ AAAAAAIAr1AAAAO4UkY Mt .r ULri llGl11.l\G3U1W (B6Turoonly)
As of 7Z a, asearoh of tho pgovld6dhame and date of blalixemaled:
No Iowa C�-Imihai IlistoiyRecord found with bCY
•• • i
❑ Iowa.Critnihal istolyRecordattacker],Del#
Dclinitlals 4.
a1Re_ce.l_yed_ _ .i_mel;Jun. 12.,n2012�.4. 40PM.No.•8„74
ARTS
Page 1 of 1
Iowa Department of Transportation
C&
^ g Office of Driver Services (Toll Free) Boa -5a2-1121
Zi PDQ Box 9204, Des Moines, 1A503BU-9294 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
8/9/2012
DL/ID #:
497AG2888 (IA)
Customer #:
5795271
Name:
Hamad, Waleed Mohd
Class:
D
ID Status:
None
Hamid
Address:
2652 ROBERTS RD APT
Audit #:
5239392
DL Status:
VAL
2C
Issue Date:
05/20/2011
CDL Status:
None
City/State:
IOWA CIN, IA
Expiration
10/29/2016
CDL Cert
None
522462740
Date:
Status:
Endorsements: 3
CDL Med
None
Status:
Mailing Address:
2652 ROBERTS RD APT
Restrictions:
Corrective Lenses
Restriction
None
2C
Date of Birth:
10/29/1979
Supplement:
Mailing City/State: IOWA CIN, IA
Sex:
M
522462740
History
Information
convictions
Citation Date Conviction Date ACD Explanation County 7UR
_ __._._.-........_ _.._.F..,..._.r..,....�,.-..__m.__....._.......
01/27/2012 03/30/2012 w ;E55 iDriving Without Headlamps or With Park Lamps :52 4A
Name: Hamad, Waleed Mohd Hamid DL/ID: 497AG2888
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:
Name: Hamad, Waleed Mohd Hamid DL/ID: 497AG2888
http://172.29.254.55/drivers/reports/customerhistorylcertifieddrivingrecord.aspx 8/9/2012
8/9/2012
IOWA
r'•••••" S'c�`-=
Office of Driver Services
Iowa Department of Transportation
Name: Hamad, Waleed Mohd Hamid DL/ID: 497AG2888
http://172.29.254.55/drivers/reports/customerhistorylcertifieddrivingrecord.aspx 8/9/2012