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Home My WebLink About13-282 Authorization Number / 1 r L P j (Office Use Only) �-_l CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 410 East Washington Street between 8 a.m. to 3 p.m., Monday—Friday.) Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX First{ I Middler n H/ Last A I? ryS 11 A 1. Name `�I J YY nffI !) 1 1-f 2. Mailing Address 2 Lt (3 I 1-24, t,-E-t' L �� / +� f- I C �vci c 4- 14 cj 1x /4 6 3. Telephone: Home /C� 55 Other: 2 6 7 5 14 q 7 Ce f 4oe 4. Prior experience in transportation of passengers: rI< Pki lam+ 1 `tki ' C�`t I — S kiLGvS 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 6. Have you be,en convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When 1 7. Have you been convicted of any traffic offenses in the last five years? i Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N 0 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) b 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) clerk/taxidrivbadg 03/2013 0 t I hereby certify thatI have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number (-r,q A ` .5.4 a Lt- . 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) ll �J Signature of Applicant 4 ,L f D , �l>M Date Z _ j `1 - *******:�t...... ......... * ........ *** **..**. .*.* *..**********.**.*,.* ***..** ** ....******.*** ......***.,*****....max***.**t STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by '(cc.5'\r �, pk.l ha SLro.�" . On this 1°l tk day of —I\Pc .eu.tVie 1 ,Iv/; WENOY S.MAYER Ltit urn 5 PM _ . „r X2942$ Notary Public in d for the State f Iowa . My. Comm scion Expires o 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 re of P7_,......,e v hief or •esignee Date l 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. )1(14-ea --k . --4 ,0_,/ / :.) - , ,.-- ___`:. Signa are of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width)and 51/2" (height) and prominently displayed to all passengers. ***.******.....*****.*.**.****.***.****.*****.*.**..*******.*..*.*****.*****..****.***.**..****.,. .,,*,..*, .**.***.*. , .*..*****....*.* Office Use Only Approved application DCI report State certified driving record Website update clerWtaxidrivbadgeapp2010.doc 03/2013 Dec. 17. 2013 3: 12PM Div of Criminal Investigation No. 8479 P. 1/1 y.,. eVT. �, „ I „ •viola „ M . N�. ,w ' P. L • eva STATE OF IOWA ,,,,„.49,,,,, �r M1, Criminal History k ecord Check r2 ax ,�lIOWA �//,,! 1.1 . �-i - fI„l`�J;j Request JE'orm �;`c r�s;l' •• DCI Account Number: 4+0 a -- F (Ifapplleable) To: Iowa Division of Criminal Investigation From: CITY OF IOWA CITY Support Operations Bureau,laifloor CITY CLERK'S OFFICE 2,15E,7'''Street 410 E WASHINGTON STREET , Des Moines,Iowa 50319 (515)725-6066 —Dati1A—CITY--1052240 (515)725-6080 Fax (Cii --) Rhone: 319 -3565041 k' Fax; 319-356-5497 lam requesting as Iowa Criminal History Record Check on: ' Last Name (mandatory) First Name(mandamiy) _Middle Name(recommended) -Ag0 +sN-11-12 V4S1 Iz )R-ISI w' Date of Birthonand®lory) _ Gender(mandatory) Social Security Number otecommanded) 2ot I9 iZ ]Male [(Female 111 --- /br b b is Watverinfonnatton:Without a signed waiver from the subject of the request,a complete ethnina(history record may not ha releasable,per Coda of Iowa,Chapter 692,2.B'or complete criminal history record Information,as allowed by law,always obtain a waiver si.nature from the sub act of there,nest, Waiver Release:Ihereby give permission for the above requasdng odelsl to con duet an Iowa criminal history record chcckwidt the Division of Criminal Investigation(DCO.Any cribbed history data concerning ma A,atis maintained by she Dcum bo Messed as allowed bylaw. 7 Waiver Signature:_ /,�i' Id 1) 1vs Iowa Criminal History Record Check Results (DCtuee only) As of illAn I U: , a search of the provided name and date of birth revealed: tEr No Iowa Criminal History Record found with DCI . I El Iowa Criminal History Record attached,DCI# • DCI initials Y D ReceivedL iel'leucii 2/102013 4: 16PM No. 4530 f Department of Transportation 8, Office of Driver Services (Toll Free)800-532-1121PO Box 9204,Des Maines,IA 50305-9244 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 12/19/2013 DL/ID#: 658A35404 (IA) Customer#: 6051382 Name: Abbashar,Yasir Ibrahim Class: D ID Status: None Address: 2401 BARTELT RD APT Audit#: 6585404 DL Status: VAL 1C Issue Date: 01/03/2013 CDL Status: None City/State: IOWA CITY,IA Expiration 04/29/2018 CDL Cert None 522462701 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 2401 BARTELT RD APT Restrictions: NONE Restriction None 1C Date of Birth: 4/29/1972 Supplement: Mailing City/State: IOWA CITY,IA Sex: M 522462701 History Information CLEAR DRIVING RECORD Name:Abbashar,Yasir Ibrahim DL/ID: 658A35404 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: • o.4y` pt)ICIE ej n e.. `¢p 12/19/2013 (VM rvices Iowa Department of Transportation Name: Abbashar,Yasir Ibrahim DL/ID: 658A]5404 •