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Home My WebLink About12-1877tar'lll�� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319)356-5040 0A«_rakvRco,9y PM (319) 356-5497 FAX Authorization Number 1,2- -/ 2,-7 APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) (Office Use Only) First Middle Last 1. NameL., 2. Mailing Address _'; �o IT Pb A( D S o,_ fA , '2') 3. Telephone: Home 3 9 A r) Other: 4. Prior experience in transportation of passengers: %1 fn Ef.. j Lu.Y1 To, )4 � c a h 6) ,) c)r-,/an —F o,- X i C6, h 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? A/ 0 Type of offense 1 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?_ Type of Offense Where 7. Have you been convicted of any traffic offenses in the last five years? Tvoe of offense Where When When 8. Has your driver's license or chauffeur's 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) uer�waxiamt,aag 06/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number 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 W 0 N M Date_L —1 �--�r2— «««*««««*#««##+«««#+#«««««#««#««««*}*««++«««+++Y.Y+Yf++«.,+.,ff STATE OF IOWA COUNTY OF JOHNSON 1516�cribed and pwoa to before me by 140LA Y A "L i ' \I CJ0LCG 1 On this 3 day of VTwA_uS+ IA4 a KELLIE K. TUTTLE commission Number zz ry Public in and for the State of Iowa 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). r Sign ture of Pot ce Cblef or designee Signature of City Clerk or designee A6;A1 S1. ?oda 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##}f#*######*#t###*R##*#tf*t#****#ff}tftf#t**fe}*##*##i####*####YY#'FYft#f##fMf11f1411!!!!!!!ltffflflffiffflf#!R#Hltfff*RflllffffMlfllf Office Use Only Approved application DCI report State certified driving record Website update cl�idfi be g.aW2010 d. 06/2012 IOWA HATIM YOUSIF JUBARA USA IA 2502 BARTELT RQNPT 1 IOWA CITY, IA 2246 OL 3C4'3AE9739 Iss 0813112012 exp 091 12012 . r 1 cl..e D end 3 s.. M Mgt 8 -08' Restriction. NONE E,..BRO DOB 0 811 211 9 7 3 MED ALERT:• DD 78283A83MH10WM120814D 3)9 X312,�6o WPTjr, • Aug.29. 2012 3:OOPM Div of Criminal Investigation ■u 11.5.". eV IL I. J,I Ili l,itf Vieth Vit, V1 lura Vity ■ rE�%ten Criminal Mstory Record Chet 1 4714411' Mi" Request Form To: XowaDivision ofCrWhalTayestigation Support Operations Bureau, V'Floor 215 E. 7°i Street Des Molnes,Iowa 50319 (515) 725.6066 (515)725-6090 Pox .. MctDaw�. Aare Of Bik th (mandatory) 62_12-1°7 ,Record Check on: NNo.�;� 7 PP. el I)CIAcoountNulnber:_�{po� f (tfeppliceble) Prom: CITY O-PIOWA CITY CXTYC CYVIIXIS OMCL 410 A WASHINGTON STREET XQWA CITY YOWA 52240 Phone; 319-366-5041 Pax: 319.356.5497 go 1Vame IMMAIa Overuale I t7 - 66, I'Mafion. Without a signed waivor Voln the subject of the request, a complete erlminnl history record may not par Code of%wn, Chapter 697,2. For complete criminal history record information, ng allowed by lau; ahvnys W2rVeP Re%dSB: lhcrc6y give pcmrission for the shove requasllng a8[nlol m conductan loaauhninal bfalary record checkwlat roe DJVlsIon otCrlminl Mvesilgolfan(DCp. Any criminal6islorydata conumingmethat fsaloinlifhed6ylhuMimayborclmscdasellowcdbylaw. Waiver 8]T N�V.{Aj4,ALLNAl+.MLV SV;�i`iVV Van .ALV VJ{.16V11 C16 L17 r,--�rluutsaenly) _,; As of U I a search of theprordded name and data of birth revealed: -1 �' No Iowa Criminal history Record found with DCI Iowa. QlminalHistoxyRecoxdaitached,ACI# _ ACI InitlalsVO hceived Time Aug. 21._2012 1:40PM No. 2153 Iowa Department of Transportation Office of Driver Services (Toll Free) 800-532-1121 PO Box 9204, Des Moines, IA 5D306-9204 515-244-9124 t FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 8/31/2012 DL/ID #: 343AE9739 (IA) Name: Mudawl, Hatim Yousif Class: D CDL Med ]ubara Status: Address: 2502 BARTELT RD APT Audit #: 6263776 ID Issue Date: 08/31/2012 City/State: IOWA CITY, IA Expiration 08/12/2014 522462713 Date: Endorsements: 3 Mailing Address; 2502 BARTELT RD APT Restrictions: NONE 1D Date of Birth: 8/12/1973 Mailing City/State: IOWA CITY, IA Sex: M 522462713 History Information Convictions Customer #: 5515286 ID Status: None DL Status: VAL CDL Status: None CDL Cert None Status: Office of Driver Services CDL Med None Status: Restriction None Supplement: Citation Date Conviction Date ACD Explanation County 3UR 08/24/2010 09/07/2010 S92 Speed 52 IA Name; Mudawl, Hatim Yousif ]ubara DL/ID: 343AE9739 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: "•"'•:X9'4 8/31/2012 IOWA tri D. O. F...... Office of Driver Services �1N,��„��= Iowa Department of Transportation Name: Mudawl, Hatim Yousif ]ubara DL/ID: 343AE9739 LE RTIFI CATE I, Lodema Berkley ,Clerk of the District Courtof the State of Iowa, in andforJohnson County, do hereby certify that this is a true and complete copy of the Original Instrument(s) filed in this / office consisting of pages. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the Seal Court at myoffi IowaCit Iowa this s�day of—_ w I TAMI DLYAN J IN THE IOWA DISTRICT COURT FOR 0 k h -f 0 (1 COUNTY IN RE THE NAME CHANGE OF: ) No. t JO o - tY �o � lt.1_ s!i V p t i2..0 IN ya V� F I V b fi,Nn, jj'yu&.w, DECREE OF CHANGE OF JUAN{ � ) (Adult) On this _day of V 20 11 ,this matter comes before tha:cfoOrt O o p upon the petition of 12dna.. i for a decree change his/her name to t t A -r, ,,- ko Ld' F and the court, being fully advised in the premises finds that a verified petition was filed more than thirty (30) days ago; that no objections to the petition have been filed; the petitioner has not previously changed his/her name pursuant to Iowa Code chapter 674; and that this court has jurisdiction. The court finds that the petitioner, who was born in —Sd 0_0 on Q— I Z - q l 3 (date) and thereafter known as IAP,tta � h �&0V) I f J b- NVJ p,,, is 5, 6 in height, weighs .}23L_ pounds, has.b Lt_, hair and p�p wn_ eyes and is a n] are A m e...` ccn (race) 0. t- (female/male). The court further finds peti- tioner is M a nre+i a a, (unntarried/married);proper legal notice has been given to petitioner's spouse; petitioner has the following children: L6 b,&n d MV ilar✓ j Poj ily pm. j a_! E f �1h%Ja�,f petitioner owns the following real estate (set out legal description): 4At and petitioner desires a change of name to {; a.T i In .' o o f i{ j v 6 a paM MV X a t,- ; The court finds a decree in accordance herewith should be entered. IT IS THEREFORE ORDERED, ADJUDGED AND DECREED that the petitioner now known as tt ^ -.oun Vo„ tj I y C�� 11 will from this day forward be known as Judge of the Judicial District of Iowa KRISTIN L. HYBBS Social Security Administration Important Information Social Security Administration SOCIAL SECURITY 400 SOUTH CLINTON ROOM 206 IOWA CITY, IA 52240-4133 Date:August 31, 2012 HATIM YOUSIF JUBARA MUDAWI 2502 BARTELT RD APT 1D IOWA CITY, IA 52246 This is a receipt to show that you applied for a Social Security card on August 31, 2012. You should have your card in about 2 weeks. Any document(s) you have submitted are being returned to you with this receipt. If you do not receive your Social Security card within 2 weeks, please let us know. You may call, write or visit any Social Security office. If you visit an office, please bring this receipt with you. To protect your privacy, we will not disclose a Social Security number over the telephone. The Social Security Administration is required by law to limit replacement Social Security cards to three per year and ten per lifetime. Do not carry your Social Security card with you. Keep it in a safe location, not in your wallet. Field Office Manager loft