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Home My WebLink About12-189CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name 2. Mailing Authorization Number - k '� A (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) 3. Telephone: Home 3' icl 6 c 6 <� 4. Prior experience in transportation of passengers: Other: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? �4, Type of offense Where When 6. Have you been c�nvicted 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? Type of offense 5 P ee Where When 8. Has your drivers 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 DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CE&IFIED 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) Gehl dnWadg 09/2012 I heertify tha I have .II'�s to me by the Iowa Department of Transportation a valid Chauffeur's license number r y A %. �� . 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 rovisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date 21 3 STATE OF IOWA ) COUNTY OF JOHNSON ) �scribedhand sworn to before me by 11ti�P\f waQ� �lotlRMe�\ _ �� OOn) this 4 day of �nJ AD Notbiy-Public in and for the State of Iowa I i 114 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 orPolice Chief or designee /-//y l 3 Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. -4f�� e -� Signat a of City Clerk or designee Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update Date de addrMv dgeaWnIO.tl 09/2012 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX First 1. NameIMtn�Qc\6 2. Mailing Address 2 LI- (�r` 3. Telephone: Home 3 19 3 3_ 4. Prior experience in transportation of passengers: Authorization Number / °2 —/ 9 (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) Other: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? n Type of offense Where When ` �Q ( C+ti) 1 Cir 6w �._A .� !vim_..-ao 1 L 6. Have you be n convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years?1 Tvpe of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Where U.NcaC♦ 8. Has your drivers license or chauffeurs license been suspended or revoked in the last five years? (7 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) � 1 �1 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) derWt drWbadg 06/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number U �2 r � I understand that if I falsely answer any questions in this application, that this ap6 may , beiee2�.und�-erstand 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) r\� Signature of Applicant N Date STATE OF IOWA ) COUNTYOFJOHNSON ) 11 scribed and sworn to bg(ore lmZy 11Iw-0a5 �E6YGt ki✓Yl. On this �T day of Notary 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). gnature of Police Chief or designee SignafUre of City Clerk or designee y -Z 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. fYY**##f###YYY##YY#i*#Yt###********R**#R****R*RRiR*fiR*1f*lflf*t11MRRf*YRifflflfllfMRff1ff11ffY*1ff11Rfff#*#ihi##H*YY#Y#f####H#*##*##*#***YR Office Use Only Approved application DCI report State certified driving record Website update aen,na.idnw WaW2010dm 06/2012 Aug. 14. 2012 2;19PM //Div of Criminal Investigation IJ.Y B� I tv lL L•JI�V1 bi v, viola V11y VI rVtln Vt Li 0 0 �1SfOPiP/B,�Mb STATE OF MWA A IGV//1 I-gtoryRevord check— II nlven}�`, Vmtxest Form To: 10MINvlsloh ofcriminallh-Vatigalion Support Operations 1311roa1l, X°l.VToar am. 71, Streot Des b'(Ainw, Town 90319 (915)73mak (515) 72S-6090 CiaY �,vK� • Criminal Zb hgh.\VA b (•-nl,- \age hA rolamblo, perCodo obtain if walversfenainl a NNo.r8830 UOPP. X3/3 u. t�Yp Of:0, `9ryKatY�°J i}CTAccountNumber: "C'b0 a^�' ' Qfeppllagblc) proms cLTr Or TOMA r.7Tv' CITY CLERIi`9 onICH 410 u. wAs09 6 rT r�cti7I e� low,4 ..5240 I�f10ttAr _12 —SDAL� r Y�AY: R1Q..a S(.—S4Q7 =hook on; Wale C 1^vpiver kom ihf 692,2, 1"O roh,ny ' di+'emaxe Middle Name f-�`'k So All Security Numb eY` Lr wh,men 303—or,92I-�- of the rognest, a eompfefd o1winal hfsfory record aroy lmt nalh3stoY}�YecoYd fnCormalloh, as allow0d by fgvr, p1(Vgys WlltYer.fieCe[Yy'e;1 pon:dyplye peralbfon ibrgronLovereg0esffng oll(cial ro mtfdyol PnTava or(m61n16krolywat0ficekwhh IhoAWon orCrWnnf Ynresdpiron(DeO. Any crimrnal Jdeloty dameonoaangme rhpAwalatarned by the Wlmrybo rafewed as allolYed bylpw. Waiver y� As of � ��1�/� �, a sohYoh of tho provided name and data of birthxwealed: go Tbwa 61minal with D Ci ci Iowa G4iminal Tdisfoq Record altaohed, ))Cx # DCx Received Time Aug. 1. 2012 2:31PM No. 0995 �-dDC�o only) �y i'1l CJ Cir TI I ZD i �r CD JCJ ' O> t O CO Iowa Department of Transportation Office of Driver Services iJ PO Box 9204, Des Manes, W 51)31&9204 (roll Free) 515-244-9124 FAX: 5155-239-1837 Inquiry Date: 7/14/2012 Name: Ibrahim, Almudasir All Address: 2411 BARTELT RD APT 2D City/State: IOWA CIN, IA 522462706 Mailing Address: 2411 BARTELT RD APT 2D Mailing City/State: IOWA CIN, IA 522462706 Name: Ibrahim, Almudasir All DL/ID: 463AF2313 Certified Abstract of Driving Record DL/ID #: 463AF2313 (IA) Class: D Audit #: 4632382 Issue Date: 08/27/2010 Expiration Date: 01/01/2015 Endorsements: 3 Restrictions: NONE Date of Birth: 1/1/1980 Sex: M History Information CLEAR DRIVING RECORD Customer #: 5747667 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 a 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 t 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: �••�•••••�'�!e 7/14/2012 D.O.T Office of Driver Services Iowa Department of Transportation Name: Ibrahim, Almudasir All DL/ID: 463AF2313 CERTIFICATE I, Lodema Berkley , Clerk of the Dlstrkt Coun of 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 1 pages. IN TESTIMONY WHEREOF, I have hereunto set myhandand affixed the Seal of said Court at my of lcnmya Cuy� Iowa Ibis day of IN THE IOWA DISTRICT COURT FOR0 -�O 6YL COUNTY TANfI C IN RE THE NAME CHANGE OF: /� I yy� r t cY t (f ` t y �j(A •✓' DECREE OF CHANGE OF N f—t /� ) (Adult) OyflO, 2 �' L I'✓at'- 20 �, this matter comes before On this _ day of OG 2� Al M i � 1D ms r._ A for a decree than 3 O upon the petition of �Flzt � 1 �R R I� t VY1 g' �plYG'9l his/her name to M A (2 0 1 a RDr- MAr>:r-n Ma AMEori"me 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 bom in S tA 0 A I on O - n l - I q 6+ () (date) and thereafter known as is � . in height, weighs k -2) O pounds, has Rj_e�� hair and RR OW eyes and is a /� Chs /a MC�Y'iCaVt(raw) (female/male). The court further finds peti- tioner is Ni fl rr 1 P (nnmarried/mamcd); proper legal notice has been given to petitioner's spouse; petitioner has the following children: �nA IJ ma(:n ECiJ petitioner owns the following real estate (set out legal description): 1 �. and petitioper desires a change of name to f ' I t' -t l .41 r Lim Ai31 E b m ( Rm6 V PN The court finds a decree in accordance herewith should be entered. IT IS THEREFORE ORDERED, ADf UDGIE,D AND DECREED that the petitioner now known as AI wtt le�u A S itt� {/�� /� R �1� 1 A � will from this day forward be known as �IJ1'R.!-:t��EFn /wdo�AMI�1J AL B Judge ofthe ("fN,Judicial District ofIowa Qr Z) Ilt / \/ Pmu n An 1 FR IOWA 2 exv J DD DOBO0i1D0AM{9800101151