HomeMy WebLinkAbout13-235 Authorization Number I a
a _ 1 (Office Use Only)
kiemagotar
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 Mokokwi,d Ei5a Ah,la1fa
2. Mailing Address\1.T7 5 \-eA 6T (7\ SA
3. Telephone: Home q-Atis 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? /t/.,
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? ,VJ
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? )V'c
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/laxidrivbadg 03/2013
I hereb certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
Lf- 6A F ?2 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)
Signature of Applicant--- "' - Date /C"—C'Lt-- 13
STATE OF IOWA )
COUNTY OF JOHNSON )
S scribed nd swornAo bef e me by `i ��110.i In 42 A A �'l C( ( . On this 4day of
tp 2-01
KELLIE K.TUTTLE
� s C mmiStin Number 221819 otary Public in and for the State of Iowa
pi M C m tssion x t s
i.t: y 5
cr,
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).
ignatu e of Police Chief or designee ate
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.
72 AJ % /l -` /,j
Signature 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
derk/taxidrivbadgeapp2010.doc 03/2013
I
r
(8311Iowa
Department of Transportation
Office of Driver Services (Toll Free)800-532-1121
PO Box 9204,Des Moines,IA 50305-9204 515-244-9124
4 ill P7 FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 9/27/2013 DL/ID#: 456AF3270 (IA) Customer#: 5737759
Name: Abdalla, Mohamed Eisa Class: D ID Status: None
Address: 2610 BARTELT RD APT Audit#: 7096945 DL Status: VAL
2A Issue Date: 07/03/2013 CDL Status: None
City/State: IOWA CITY, IA Expiration 09/17/2015 CDL Cert None
522462731 Date: Status:
Endorsements: 3 CDL Med None
' Status:
Mailing Address: 2610 BARTELT RD APT Restrictions: NONE Restriction None
2A Date of Birth: 9/17/1980 Supplement:
Mailing City/State: IOWA CITY, IA Sex: Ni
522462731
History Information
Convictions
Citation Date Conviction Date ACD Explanation County JUR
09/12/2010 '11/16/2010 1M14 'Fail to Obey Traffic Sign/Signal Johnson !IA_ ,
10/31/2010 11/29/2010 S92 Speed (Johnson IA _i
09/30/2012 10/30/2012 IS92 Speed Jefferson 'IA ;
06/24/2013 07/31/2013 ;M14 Fail to Obey Traffic Sign/Signal lWapello 'IA
Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date Case Number JUR
03/15/2011 622299 IIA
Name:Abdalla, Mohamed Elsa DL/ID: 456AF3270
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:
tf11C(f';`'a
$t.' ..453 4, 9/27/2013
s IOWA tto
,+ s
� \
I�OSe of D
ervle�BRIBIowaDepartment icansportation
Sep. ,7. 2013 4:49PM Div of Criminal Investigation/ NNo.,5130 P. L2/3
IMPIRelllk
tr
VHF3 .:'As 1,k agivot7F`orm l aioatiwsps
.
' RC,imoounomoben �0� P
• • (lEbppl(crbpo) , •
' Lo; SowYa1:01s1Qn Or CriminglxnVaatlggfetl .5Y0n5 rrTY ob' TDWA IT'W •
Supportoparar°nsRurcaw,i°1not - czzx exam's o7/:lx
2,18`x.7e1S(reat • 470 8., WAriHSflGTOlq'SvRRET
)IOO pIrtav,YAW 50119
O1 7as 6266 • IOWA ant TOVIA_ 52,340
(516)925-6060 )10 .
S triune./ PI J
t.•W) 31q-.ASF--56.47
Ifemrequostingart Tom CrimhnplRI* Record�Cyheokow uY • ' •
Last Maize maniaa° ' r1tNtlittOQndrtJe(ary} ' Middle aua(racorMGdd)
I
lYnt`°agirift(mophroy) (�ey{.(10rrOmnaataq,) ��--(r y L4oAilgoptitityPltilnbor(rooemmeadet
•
OC).- \9t, 'c> Wee ' Mkt.
ate 04A�,� '_ 7 )^j e (('
1l1fer igb)v1rAUa)7 Y/1(Bout*s(gnaatvat' xnYom,thasubjeototfhexar�nas4ntornp00E0viitnikahi oryreeordmayamt
.ha roTaynbla,pay Cada df'Ynwprampler 692.2.Ira.cotgprerarim/oa(historyrecordiriformatlo>t,rig afawedb'Tht always
alai s7yp'atvereffm NPali nlTOsukbdtorgiestegll6sf' ,
J fver-REteaj'l;nevaigrvaparm(q(ORibrllfbn6nverrg4tsltogotralgfoaotolegrav;avr(minddLmtyteaofdpSec W/II])ia))ld3)o?t t ,nindf •
Tnvastrgallon(acn.Any rdrn(aelld:mtYdenoolinmfugnrfietIS aaTnta(nedh ho bonny 6aWawa'ar1fowc4byl6W.
WtIvor.Slgnaldlre< -- -r► • •
I
Au of 91—LC 13 ,aseiirtha:thokrovid'artnarmeaka ago os'biithaeveaYed: ' .
it Thoma C5.in lrlatIlistoxyRecowlround wifftDC1' •
. . ..:.• : ...: ' I I.
El Iowa 1 IntineIINisigzyRecord atfaohed,ig atit `'"
Received Time Aug. 29, 2913 4:30PM No. 4359 '
1 'rift?Y_Yir_1_