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Home My WebLink About12-251CITY OF IOWA CITY 410 East Washington Street Iowa Cid,_ lowa_.5222�240-1826 C-(319) 356-5040 _/I k io'lg (319)356-5497 FAX Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) /,�_)-a5/ (Office Use Only) First Middle Last 1. Name 5Am1y T",k-A AM I N 2. Mailing Address '_('OS (3or�� At P_d 1 t— 1/A z -;t --Lea, 3. Telephone: Home 3 \ ct 2- -5 � S, o 0 7_ Other: LIS I M -a, o B )_ 4. Prior experience in transportation of passengers: 3 DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED _ DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR ICE 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 reviewe� the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) dwMmidrivbadg 09/2012 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? it/ U 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?_ ./' O Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? T/ 1> Type of offense Where foe When 8. �Pas yAr driver's license or chauffeur's license been suspended or revoked in the last five years? -v 6 Tvpe 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 ICE 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 reviewe� the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) dwMmidrivbadg 09/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license numbeP. 2 S'S b n 3 A t `-f . 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 (0- (cl -12- STATE l2 STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by S c, m; r` f 1 On this If day of � r SONDRAE FORT Sa dct � Sv1Gb Commission Number 159791 My Commieeinn Frrvree 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). Signre of ;0 s a Chief or designee 1V `1 /-1� 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. " . 'u') g�S nbture 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 1d'/y' /'=a - Date derMt drivba geappM0do - 09/2012 11 Oc:. 1. 2012 10;19AM 1VV L. 11. LV 12 L'. -r II I4 Q��pt6dP PVVIA e, Div of Criminal Investigation Ulty Vlelh bl Ly UI IUI'In bILy (brA minaMstoryReco>ra Cheek Requ" l Form No. 9821 P. 3/3 n u. 111 L r. L/ L . _ 1aCTAccounEN-umber: ��Do� F ' � QPapplfeCD o) To; YOlYA Y1SGIslgn Of Cram{I1AI 1}1 Ve9FPgnl(6h kl olnf • OTTP oy -[017A CTgy Support OperaffonsR1(rgg%1'17Bloor CXTX C7xw"q ob'F•lM- z18E,714, (root 47n E- wAWMC�rnrr aZgX T boshWrfw,Towa Su319 (913)72H-6066 7011lA, CITY 70174 52240 (515) 72S -60H0 hast , pRon9; _ 319-45F--So41 1?flXf RYq•-ASH-54o� �J 1' am reuastln arLIoWA Crfminel IIl 0 Record Chook on: Last NMe 6man6>(o Ei A N`afae (monNoly) Middlo NRMe ([eLomefo4doa) �qteo£BiNYh mendero�3 C�611Qvr andafq) $f7CfalSCCU1it{/lVgfil)CY (oCgponchded — r I dMa1e ❑JB emaTe i 6 2 `� a 8 5-7 nIVe1 f;/ br7nmY0J,'WlthoutasfA'naai J?ANoy*omlhosubject ofthexequageil tnp)vtovl'flu[nAlblsforyrecordmaynot $a roIsAsnbley per CoLTe o£Yo{yA, Ch aptes• S9Z,7v )77or goM� ta"crt'1ntSnnlSlstory recoxd 1nlbYmntlo>z� as allowed 5y lgtt%I AlfYays ' obP31Yt alerarsl na(uxeR"pmfhe-sub ooCoitliek 4sh' �YlLlit'eY�E1L[l1.�8:1IICfcCyBlVo permlzyfdttfot IhbnhoVeregoaslldf7oflloi0f !o rndduclen TuLVnoylminnf 6ltlory [uo[dC$acK Wf1h IIiaDNisloa gPCrfminu( yavcsllealtoA(IM'D.myu1n)lnelJdaforydatatonaomfrtg La Ulnrlsmo(nlolned6glhobo/,ney6arof�esednsnfloweQEylgW. - 1 Wrrlver,SteHalreYe; _ ,,., �ioyya �'x1zxtal k�stop�.laecorhece�tYY� . (QCj:v�qunly� ` A o£ 1 �, a search bf thls plovid'ed name and data o£bii4 -sO voalod; ;; . i %rolbw/aGSltninalS rst0VRocord£oundwJ01))CX —� ❑ rows L�ilninalllfstgsyReColdattaahed,1) �' bCi il7illalsb a„',.�;�. ,,a T�meun.l 11 9n19 tOM K�„ 6n 1n Iowa Department of Transportation Office of D&er Services (Toll Free) BM -532-1121 PO Box 9204, Des Moines, ]A 5006-92U4 515-244-9124 FAX: 515-239-1837 Inquiry Date: 10/19/2012 Name: Amin, Samir Taha Address: 2608 BARTELT RD APT IC City/State: IOWA CITY, IA 522462730 Mailing Address: 2608 BARTELT RD APT 1C Mailing City/State: IOWA CITY, IA 522462730 Convictions Certified Abstract of Driving Record DL/ID #: 255DD3914 (IA) Customer #: 4327702 Class: D ID Status: None Audit #: 5708685 DL Status: VAL Issue Date: 12/28/2011 CDL Status: None Expiration Date: 01/01/2017 COL Cert Status: None Endorsements: 3 COL Med Status: None Restrictions: NONE Restriction None Date of Birth: 1/1/1963 Supplement: Sex: M History Information Citation Date Conviction Date ACD Explanation County 7UR 04/06/2008 04/09/2008 592 `Speed 52 IA 09/07/2008 .10/0_7/2008_ _ _ S93 �M14 Speed 52 IA 01/OB/2011— _ 02/11/2011 Fail to Obey Traffic Sign/Signal :52 IA 09/01/2011 10/02/2011 592 Speed '7 IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number IUR 09/06/2008 458497 'IA Name: Amin, Samir Taha DL/ID: 255DD3914 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: D +"' •"•;`/''4 10/19/2012 IOWA `*''ii�,s D.O.T.' Office of Driver Services Iowa Department of Transportation Name: Amin, Samir Taha DL/ID: 255DD3914