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APPLICATION FOR TAXI DRIVER
CITY OF IOWA CITY (Police Department review must be made
410 East Washington Street between 8 a.m. to 3 p.m., Monday — Friday.)
Iowa Cit . Iowa 52240-18 6q/5
356-5 �
(319) 356-5497 FAX
First Middle Last �n
1. Name 1 WA/2 Ir�MAI_ FIN)v Fl_C,Fi1 F ,eA A kJ /"/ {-, 11
2. Mailing Address
3. Telephone: Home '1 f/+ Other: ? Ig 5 22 qq 7'7
4. Prior experience in transportation of passengers:
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5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? T()
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?N&
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where When
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8. Has your drivers license or chauffeur's license Been suspended or revoked in the last five years?
TVDe 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)
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I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
?Z? d F () 152 . 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 1 Date
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STATE OF IOWA )
COUNTY OF JOHNSON )
S gibed and sworn to before me by —r b t �ItiMt".p� On this 5��� day of
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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).
Sign t e of Police Ci or designee
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Signaftrre of City Clerk or designee
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Date
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Date
NOT VALID UNTIL Police Chief and CityClerk have approved and authorized taxi driver names placed on the citywebsite at
icgov.org. '
Taxi cab businesses are required to provide Driver Identification cards.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
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Received Time Aug.29, 2012 2:54PM No..2400
r Iowa Department of Transportation
i 0 Office of Driver Services (Tall Free) 800-532-1121
PO Box 9204, Des Moines, IA 50306-9204 515-244-9124
FAX: 515-239-16137
Certified Abstract of Driving Record
Inquiry Date:
8/24/2012
DL/ID #:
363AE0153 (IA)
Customer #:
5539274
Name:
Ahmed, Ihab Kamal
Class:
D
ID Status:
None
02/25/2010
Eldin Elshie
S92
Speed
52
IA
Address:
915 A AVE NW
Audit #:
5340218
DL Status:
VAL
Issue Date:
07/01/2011
CDL Status:
None
City/State:
CEDAR RAPIDS, IA
Expiration
06/25/2014
CDL Cert
None
524054824
Date:
Status:
Endorsements:
2
CDL Med
None
Status:
Mailing Address:
915 A AVE NW
Restrictions:
NONE
Restriction
None
Date of Birth:
6/25/1970
Supplement:
Mailing City/State:
CEDAR RAPIDS, IA
Sex:
M
524054824
History Information
Convictions
Citation Date
Conviction Date
ACD
Explanation
County
OUR
01/03/2009
01/11/2010
S92
Speed
92
IA
02/25/2010
04/07/2010
S92
Speed
52
IA
05/02/2012
05/23/2012
S92
Speed (10 mph & under In 35-55 mph zone)
7
IA
Name: Ahmed, Ihab Kamal Eldin Elshie DL/ID: 363AE0153
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:
-..........
8/24/2012
IOWA *
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Office of Driver Services
wOHIO
Iowa Department of Transportation
Name: Ahmed, Ihab Kamal Eldin Elshie DL/ID: 363AE0153
Cedar Rapids DL Station
K -Mart Plaza 152 Collins Road NE Cedar Rapids, IA 52404
Statement Receipt: 27472929
Customer Information Office Information
Name: Ahmed, Ihab Kamal Eldin Elshie Date: 8/24/2012 10:59:47 AM
Address: 915 A AVE NW CEDAR RAPIDS, IA 524054824 Location: Cedar Rapids DL Station
Phone:
Fax:
Email:
Attached Customers
Name
Ahmed, Ihab Kamal Eldin Elshie
Transaction
Type Description
MISC Finance Transaction - Ahmed, Ihab Kamal Eldin Elshie
Product Amount
Sale of Records - Certified $5.50
Payments
Payment Method Payor Payor #
Cash Ahmed, Ihab Kamal Eldin 5539274
Elshie
Total Due:
Amount
$5.50
$5.50
Number Amount Tendered
NA $6.00
Total Tendered: $6.00
Cash Back: ($0.50)
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