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Home My WebLink About13-263 r Authorization Number / • r _ 1 (Office Use Only) APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (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 Middle Last 1. Name h ed R 1 C. 1&6N3 J 2. Mailing Address n Li 2 IA, 'h 5 P v i to vee ck u 0 0 ti o�a , ty A !Z 3. Telephone: Home 5 ) 9 3 a `) _ Other: 4. Prior experience in transportation of passengers: 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 been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? sec ',A-4r/ Type of offense 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) clerk/taxidrivbadg 03/2013 c 7s/Vo I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license'numbstir Z. \ L c c cj cu O . 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 I I — I S STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by �b�-e_� . ‘PbN . On this t S day of ?(3( f q Nbtazy Publ in and for the tate of fawa ************************************************************************************************************************************************ 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). f// Si ature of Police Chief or 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. Sig re of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 5 Yz" (height)and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update clerkitaxidrivbadgeapp2010.doc 03/2013 Nov. 14. 2013 11 : 03AM Div of Criminal Investigation No. 2151P. 5/8 Nov. 1, [UlJ IU: iI M City (Jerk - t.ity or Iowa t, ity No. riuo, P. J , • `3��icr14ae'k'.5\ STATE OF IOWA ` cvr.ftt -'ii ;2r Criminal History Record CheccA \ , : Request Form DCI Account Number: K oo& - F' (if applicable) To: Iowa Division of Criminal Investigation prom; CITY OF IOWA CITY • Support Operations Bureau,ill$loom CITX CLkR1C4 S OFFICE 215 E.7th Street 410E WASIIINGTON STREET Des Moines,Iowa 60319 (615)7254066 ..IBtde--rITY IOWA 5221ii 0 (515)125.6080 Fax phone; 319-3565041 Fpx; 319-356-5497 I am requesting an.Iowa.Criminal History Record Check on: LestName(mandatary) First Name (mandatory) Middle Name eeeommcndca) _A(7 Jet Ra3° 416(611/40. k. Oi M Date of Birth(mandatory) Gender(mandatory) Social Security Number(reaorranendcd) `Y I2MaIe ❑Female Ll — 7— G a 2 Waiver.Txsfortnailoii:Without a signed waiver from the subject of the request a complete criminal history record may not bo releasable,per Code of Iowa, Chapter 692.2.For completq criminal history record information,as allowed by law,always obtain a waver signature from the subject of the request. Waiver Release:Thereby give permission for tho abovo requesting official to conduct an Iowa criminal historysecond chcokwhh the Division of Criminal Tmesligation(DCI). Any edminal history data concerning me that maintained by thcDClntay be mimed ae allowed by law. Waiver Signature:. _ I. —stag V y r 4 Iowa Criminal History Record Cheek Results (DCIuso only) • /�7' As of §-711-43 , a search of the provided name and date of birth revealed; Pit No Iowa Criminal History Record found with DCI 0 Iowa Criminal History Record attached,DCI# • DCI initials C . Received Time7Jov,'7.1C'2013 10:29AM No. 1494 l Iowa Department of Transportation Office of Driver Services (Toll Free)800-532-1121 1*411111. PO Box 9204,Des Moines,IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 11/6/2013 DL/ID #: 214CC9840 (IA) Customer#: 4313828 Name: Abdelrazig,Abdel Rahman Class: D ID Status: None Mohamed Address: 2442 WHISPERING Audit#: ' 7502039 DL Sthtus: VA.L , MEADOW DR Issue Date: 11/06/2013 CDL Status: None City/State: IOWA CIN, IA 522406805 Expiration Date: 01/01/2015 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 2442 WHISPERING Restrictions: NONE Restriction None MEADOW DR Date of Birth: 1/1/1956 Supplement: Mailing City/State: IOWA CITY, IA 522406805 Sex: M History Information Convictions I Citation Date Conviction Date ACD Explanation County SUR 12/23/2011 01/03/2012 592 Speed Johnson IA Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. , Accident Oak Case Number IUR 10/14/2011 - .653163 IA' 109/08/2012 702582 'IA Name: Abdelrazig,Abdel Rahman Mohamed DL/ID: 214CC9840 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: f,`k.— .A 11/6/2013 1;'IOWA z, ;?: ; 5-P a evestoas4 '7.4,...D. O. T...4.25 ,,,€.4.,. .17 of Driver IN S Iow a Department eeof Transportation Name:Abdelrazig,Abdel Rahman Mohamed DL/ID: 214CC9840