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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
356-5 40
(319) 356-5497 FAX
1. Name
2. Mailing
3. Teleph
Authorization Number /9-a�R ?)
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
4. Prior experience in transportation of passengers: T
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /tel 0
Type of offense
Where
When
6. Have you b en convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? N C)
Type of Offense Where % When
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense
When
/0 -IN- 2
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)
uerknaxitlrivbadg 06/2012
I hereby cern that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
3L/ A F rf 4 / / I understand that if I falsely answer any questions in this application,fthat 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
s granted, to comply at all timeswith all f the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public) �n
Signature of ApplicantDate 9 - 20 -ZO i)-
STATE OF IOWA )
COUNTY OF JOHNSON ) 1
Su ribed qnd s rn t before me by 1 khe r t CGLVI I ZGZ On this day of
�o),/ II
KELLIE K. TUTTLE
o fi Commissio Nu ber 221819 Notary Public in and for the State of Iowa
ARE
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).
a z
Signal re of PoliteChfdor designee
/
Signature of City Clerk or designee
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.
Office Use Only
Approved application
DCI report
State certified driving record,
Website update
CehnexidivbadWapp2010 d 06/2012
Iowa Department of Transportation
Office of Driver Services (Toll Free) OOD-532-1121
PO box 9204, Des Moines L4 5[}31i 9204 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
9/5/2012
DL/ID #:
346AE4411 (IA)
Customer #:
4810504
Name:
Hamza, Elkheir Mohamed
Class:
D
ID Status:
None
Awad
Address:
2401 BARTELT RD APT 2D
Audit #:
4442025
DL Status:
VAL
Issue Date:
06/17/2010
CDL Status:
None
City/State:
IOWA CITY, IA 522462701
Expiration Date:
10/02/2014
CDL Cert Status:
None
Endorsements:
3
CDL Med Status:
None
Mailing Address:
2401 BARTELT RD APT 2D
Restrictions:
NONE
Restriction
None
Date of Birth:
10/2/1970
Supplement:
Mailing City/State: IOWA CITY, IA 522462701
Sex:
M
History Information
Convictions
Citation Date ,. Conviction Date ACD Explanation County 7DR
..._. ........ _. ..._....... .__..... ......... ...._............. . ................ r- . ,.........
08/15/2009 110/14/2009 ?S92 Speed E52 :IA ...
Name: Hamza, Elkheir Mohamed Awad DL/ID: 346AE4411
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:
'•.:,,,v 1
9/5/2012
IOWA
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Ste-
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Office of Driver Services
Office
Iowa Department of Transportation
Name: Hamza, Elkheir Mohamed Awad DL/ID: 346AE4411
Sep. 20. 2012
Sep. 5. 2012
2:18PM Div of Criminal Investigation
4:33PM City Clerk - City of Iowa City
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