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Home My WebLink About12-202Ott CITY�r"III CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 z T/z3 (3 19) 356-5497 FAX 1. Name 2. Mailing Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) First Middle Last 1A _ `V /, (Office Use Only) 3. Telephone: Home 319 - 4 C' e, —3 g S '5? Other: 4. Prior experience in transportation of passengers: 3 yc�w 5 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Y10 hP, 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?t) 0 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? CS Where 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) clerkA dnWadg 06/2012 A- I I hereby certi�j�-that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number i r Ufa //3� 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— Date__ $ - 3J - **RRR1R1f*fM###*H##*#11111ffY########f*#tf*11111##*####R#**f1111111111##1f'k*Y##R*ff*}fiflfi1114i###RRf*f*Hfifffllf#f*#k****f1Hf11M#*+1e**iff STATE OF IOWA ) COUNTY OF JOHNSON ) bscribed and sworn to before me by I t � O V a -r' ^e-& I 64-cr — L(O- . On this J t day of KELLIE K. TUTTLE Mobgr z2161s Notary Public in and for the State of Iowa My Co iss n xpiras ow *f*4A*4ffkf#4k**k****ffi1413###kk*ii*ttf4#f##f;t***k**k***#t*4kffY#;#*t**k********##lk;;#k**t*#k**#f#4#4433##kit#flit*4##344tt#;*kk*4f43f444Yk## 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). 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. #++1111#11fM#Y##+#1+f#1tfiHfYY##+#4+1111#fYY#Y#f*f+f+lR1fH11M###++##++*##1f+f11fYf'Y###++++#fllf+lfYffYY##*fFk*#+f++ff111fYfY#ye*#1f1f11fH**f* Office Use Only Approved application DCI report State certified driving record Website update cie,a ddmadgeaW2010.� 06/2012 AwA4. 2012 3:07PM Div of Criminal Investigation nos, 1c. cuIc 4:41riv blty oierK - t,1ty 0 lowa u i i y �,� fth� I I OFIOWA l -.rrrta. �p`3.. Requot Form To: Iowa Division of Criminal Investigation Support OperalionsBureau, VIFloor 219 2. 7" Street nas1V141ne9,Iowa 50319 (515) 725.6066 (515)1125-6000 I+ax an Check Cendeir No. 0863 P. 3 No, 1119 P. 2 DCI Ac count Number: -(O05--r- (If applicable) From; CITY OF IOWA, CITYi CITY CLBRX'J 0)?FICR 410 E, WARUINOTO1V STRBRT IOWA CITY IOWA 52240 Phone) 319.356-5041 Faxi 319356.5497 M ko" n-" s I Ikale ❑Female I [><iq--Qt.b --'7 J d 4 1 Waiver.ruformalton: Without a signed waiver from the subject of the request, a complete criminal hUfa y record May not I be releasable, per Code of Iowa, Chapter 692,2,)For com late criminal history record infolmatlon,asallowed bylaw, always WIIIYBp,ReIB!U:Ihucbyglvopohohsiatfor tl,eebnvarogUestingofficlattowndudanrowacriminatLi loryfaordohmkwilhdoDlvlalonofCOminal 7nvastlgodon (DCH Any aimh;al Atory data eonumingnro that is malniatned by llto DCltnay be released as eaoweA hytmv, Xowa-Crimigal History Record Check Resullt� �' cr naaily) — -:: .n As of a search of the provided name and date of bird) revealed: ^, cr 'rJ0 No Iowa Criminal HistoryRecoid found wifli DCI ^ == r r Co ® Iowa Criminal History Record attached, DCI # DCX :nrnioer� Time And 14 9019 A•AIPM G KA Iowa Department of Transportation i 0 Office of Driver Services (Toll Free) 800-532-1121 PO Box 9204, Des Moines, IA 50306-9204 515-244-9124 FAX: 515-239-1837 Inquiry Date: 8/15/2012 Name: Abdalla, Mohamed Elsa Address: 2610 BARTELT RD APT 2A City/State: IOWA CITY, IA 522462731 Mailing Address: 2610 BARTELT RD APT 2A Mailing City/State: IOWA CITY, IA 522462731 Convictions Certified Abstract of Driving Record DL/ID #: 456AF3270 (IA) Class: D Audit #: 5425005 Issue Date: 08/06/2011 Expiration Date: 09/17/2015 Endorsements: 3 Restrictions: NONE Date of Birth: 9/17/1980 Sex: M History Information Customer #: 5737759 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Speed Citation Date Conviction Date ACD Explanation County 3UR 09/12/2010 11/16/2010 M14 Fail to Obey Traffic Sign/Signal 52 IA 10/31/2010 11/29/2010 S92 Speed 52 IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number IUR 03/15/2011 622299 IA Name: Abdalla, Mohamed Elsa DL/ID: 456AF3270 Pursuant to Iowa Code §321.10, 1, 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: +•""'•:;v/,y'4� 8/15/2012 IOWA J.O. T. 5i r ••••••$�Q= Vii,=- Office of Driver Services `\go Iowa Department of Transportation Name: Abdalla, Mohamed Elsa DL/ID: 456AF3270