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Home My WebLink About13-277 Authorization Number `7 `7 1 r 1 (Office Use Only) =it 1"n.fliNg41111n" ECG 4.1 CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 4 1 0 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 Middle Last 1. Name f}Tt'L /ddll'41n 2. Mailing Address t 6 14 N ;5—n n/ % j a c et G/77 LPrj 2 2 L 0 3. Telephone: Home 3,/,33_1_ Other: 4. Prior experience in transportation of passengers: ;iek\i r 4,'\‘'t )- 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? ;A/ a 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? p/ Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? --a Vej Type of offense Where When Coy /--/3 1� 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) clerk/taxidrivbadg 03/2013 hereby certify that I have issued,to me by the Iowa Department of Transportation a valid Chauffeur's license number L it,' h a \\ ► . . 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) -_ II _ 1 Signature of Applicant (-_ •}1/1 Date \ 2 / 12 I i 3 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by _\ 4,..k% \ 'r�, �, .,s,\\,..\,..,,,..) . On this \2 day of ..as).tc.Arw.b-•.r 'ad,L3 . \S.v w( , o blic in and for the State2Sf Iowa '713t("I **********************************************************************************************************************************************.* 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 -/ Sign re of Po "e hi�+r designee 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. i/Lt:4',7_/ • ---'44A./ i. - i .--i_S 72 iS gnatbre of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width)and 5 1/2" (height)and prominently displayed to all passengers. **********************.********************* ,,,,************.**********.**************.....*..*....**.....*.***....*.........*...........,..** Office Use Only Approved application DCI report State certified driving record Website update cie k/k taxidrivbadgeapp2010 doc 0312013 riilIowa Department of Transportation Office of Driver services (Twl Free)800-532-1121 PO.Box 9204,Des Moines,IA 50306- 204 515-244-9124 FAX:515-239-1937 Certified Abstract of Driving Record Inquiry Date: 12/12/2013 DL/ID #: 617XX3816 (IA) Customer#: 2345972 Name: Abdallah, Elfatih Class: A ID Status: None Hussein Address: 16 ANISTON ST Audit#: 7169570 DL Status: VAL Issue Date: 07/25/2013 CDL Status: VAL City/State: IOWA CITY, IA Expiration 06/21/2018 CDL Cert Excepted Interstate 522402216 Date: Status: Endorsements: NT CDL Med None Status: Mailing Address: 16 ANISTON ST Restrictions: NONE Restriction None Date of Birth: 6/21/1972 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522402216 History Information Convictions , ' Citation Date Conviction Date ACD Explanation County JUR _ 01/13/2013 :02/21/2013 . 592 ;Speed -kIowa __ ;IA ! Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date ,A Case Number JUR 11/20/20081472653 ., _ ,s IA 06/24/2010 .. . , 1578332 r:..._ :IA 12/03/2011 1660530 jIA Name: Abdallah, Elfatih Hussein DL/ID: 617XX3816 • 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: uay nil... .7Gj y, 12/12/2013 I Pt/ IOWA. 'y'' y - y^ fl .aJa owaaDepartme tServices Transportation Name: Abdallah, Elfatih Hussein DL/ID: 617XX3816 Y Dec. 11. 2013. 1 : 22PM Div of iCriminal investigationy ,N o. 7883 I . X1/4 MN 'Nut STATE OF IOWA k<:. y. �r i?11��! Criminal History Record Check i. 4. . th• .k�r)� 4, Request Form nr .5%;-aye DCI Account Number: lion (if epp`f(cab c) To: Iowa Division of Criminal Investigation From: CITY OF IOWA CITY Support Operations Bureau,In Floor CITY. CLERK'S OFFICE 215 E.71h Street 410 E WASHINGTON STREET Des Moines,Xowa 50319 (515)725-6066 . (515)725-6080 Fax none; 319-3565041 Fax; 319-356-5497 I=requesting an Iowa Criminal Risto _Record Cheek on: ' Last Name (mandatory) 'first Name(mendaloty) Middle Name(recommended) • F\ ‘{‘kk, E L 41- (A- . . 1.A Date of Birth(mondetor» Gender(mandatory) Social Security Numberirecommended) a6/ , I // 2/ 72 4.93 - 2,1 -- 9 6p • Male Memale Waiver Information:Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Code of Two, Chapter 692,2.For complete criminal history record information,as allowed by law,always obtain a waiver signature from the subject of the request. Waiver Release:TherebygivepermisslonfartheaboverequesiingofficialtoconductenIawacriminelh,story ordcheck with teDivisionofCriminal Investl6dion(DCl). Any criminal his tory date concerning mo that ismairaeinedby the DCI may b o release d as eller d bylaw. YX'aiveNSig»nlure: ' -----------:---tri 0-02a-47 YV(,er. - Iowa Criminal History Record Check Results (DClute only) As of 1 a` 1 t \ 13 , a search of the provided name and date of birth revealed: . No Iowa Criminal History Record found with DCI r : 0 Iowa Criminal History Record attached,DCX# DCI initials ,Kz_ Received TimeTDec. 5. .02013 4:36PM No. 3979