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CITY OF IOWA CITY
410 East Washington Street
l0 224 -1826
19) 356-5040 VA;1Y
(319) 356-5497 FAX
First
1. Name
Authorization Number Ij- )S3
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday - Friday.)
Middle
Last
2. Mailing Address o< 4 0� tt c 04 �Oyla C \-�j � : 9
3. Telephone: Home Other:
4. Prior experience in transportation of passengers: �) KAS c��w eY 0\�2 'S S-"\5
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? _I N
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? V\ice
Tvpe 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 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)
de .id,wb.dg 06/2012
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
'17 L+ q C'T � �ZI understand that if I falsely answer any questions in this application, that this
application may be denied. I understand that if'l 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 I � � YA Date o� I
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STATE OF IOWA )
COUNTY OF JOHNSON )
&rMvv'a Al i Yy\�
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).
Signature of olice Chief or designee
SigClerk of City or design
y-?�-/ -,L-
Date Date
Z—,-�2-fs — i --
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.
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Office Use Only
Approved application
DCI report
State certified driving record
Website update
�ian�.a,#,oPzoi o.aoo
Aug. 21.' 2012 3:39PM Div of Criminal Investigation))
... C IV. I. 0 I ,. , L I I a. — e, i, v, V I n v I„ V I , V p Y V l l)
hNo.1011L03 P. L5
STATEOFIOWA
Criminal
� TT} IOYIA "► History
?4�F�"✓ 6i''✓Request Form�LnY� DCIAcaonntNutuber
To: IOWA ]Division of Criminal inyestigation
Support Opertltlons Boileau, V' Ar)oor
215 r;. 911i Street
Des Moines, Xewa 50319
(515) 725-6066
(515) 7a5-6060 b'ax
I ainreauestina an Iowa Criminal Mstolyliecord Check on:
From: CITY O$ IOWA CITY
CITY CLBRIr'5 OFFICE
410T, WASMWGTOFISTRRFT
IOWA. CITY IOWA. 52240
Phone: 319-956-6041.
1rax: 319-396-5491
I.ragtXakae(mendnro
,1+irstNama (mandatory)
McidleNa1II00«ommcndeai
Aum
Qr�,
Date of Birth(mandatory)
Gender mandatory
Social ,$ewdly1 lihibB'(rccommaided
D -Y / ado / Jam/ 96
Omale 0I1emale
Walyerbilbrihatkii: Without asigned wmverlYomilia subjectofilia request, acompletocriminalhistory Yeeordmay not I
be releasable, per Cade ofrown, Cttaptor 692,2.Fm
or coplete crlmfnal hlstoryrecord infocmafion, asallowed bylaw, always
Walvet<12e%CaS'6:limreby givc pcmiission Yortho above requestngofficfal to condued an IOwa almhtel114101ytewrd eheckwtdt dlo Division otCominet
Invastrgatlan(ACn, A Y"inlinel bythaDCtmay beteleosed m elfawed bylaw.
M
Iowaa, Criminal History Record
P
As of `� a search of the rovided name and date of birth zevealed;Cj
:Y
No Iowa Criminal History Record found Vith DCI
t _
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a
n
X,
,
® Iowa Ckiminal Histoxy Record attached, DCT #
DCX
deceived Time Aub; 1.�,„2D12 12:18PM No. 153
C/''` Iowa Department of Transportation
� j Office of Driver Services (Toll Free) WO -532-1121
PO Box 9204, Des Moines, IA 50366 92Ud 515-244-9124
FAX: 515-239-1 837
Inquiry Date: 8/16/2012
Name:
Allm, Ammar Osman All
Address:
2401 HIGHWAY 6 E APT
DL Status:
4004
City/State:
IOWA CITY, IA 522406721
Mailing Address: 2401 HIGHWAY 6 E APT
4004
Mailing City/State: IOWA CITY, IA 522406721
Certified Abstract of Driving Record
DL/ID #: 549AG7733 (IA)
Class: D
Audit #: 6123762
Issue Date: 07/13/2012
Expiration Date: 04/20/2016
Endorsements: 3
Restrictions: NONE
Date of Birth: 4/20/1985
Sex: M
History Information
CLEAR DRIVING RECORD
Name: Allm, Ammar Osman All DL/ID: 549AG7733
Customer #:
5876361
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:
•.!,P
8/16/2012
10WA•J'tr�y
14
f09 S=
Office of Driver Services
.ti
Iowa Department of Transportation
Name: Allm, Ammar Osman All DL/ID: 549AG7733