HomeMy WebLinkAbout13-151 Authorization Number iI1 5
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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 4, pf-,-RcA ('Aks) k-LNNA N V1
2. Mailing Address \\JN:5- 3
3. Telephone: Home 3\0\ - 3 S`- \EiE Other: 3\c LU\--
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
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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? 'lc-5
Type of offense Where When
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8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /T'-�
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)
clerks axidavbadg 03/2013
9'S-7 /IA 9s_377
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
C-\S cA A- IN sk S 3 . 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 ' -" 2 �_
************************************************************************************************************************************************
STATE OF IOWA )
COUNTY OF JOHNSON ) r
Subsc ibed and swornto fore me by ��C� (c`f �`�
�� �Ct 1�1 y` e, this day of
Lk_ ‘1_� 1 4' I .=.) -
KELLIE K.TUTTLE Notary Public in and for the State of Iowa
iiccio Plum or- 1810
!cn n5- ExUpires
***************************************************** ******************************************************************************************
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).
f7-2Y-/ 3
Sig ture of o icor 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.
Signature of City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/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
derk/taxidrivbadgeapp20l O.doc 03/2013
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Jul. 16. 2013 10: 34AM Div of Criminal Investigation No. 0341 P. 2/2
IOWA CRIMINAL HISTORY DCI 00029076
MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1
DATE PRINTED-
' 2013/07/16
DCI:00029076 •
NAME: ALAWNEH,RAFAT AHMAD
DOB SEX RAC HGT WGT EYE HAIR SRN POB
19780906 M W 509 191 HAZ BLK FAR YY
ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y
CCH RECORD ***
01 ARRESTED 20080307
AGENCY: IA0520400 IOWA CITY UNIV SEC PD
CHARGE NO- 01 IA STATUTE IA711.3-2
ROBBERY 2ND DEGREE - 1978
TRK#: 1A003L101
COURT DISPOSITION •
AGENCY: IA052015J JOHNSON CO DIST COURT
COUNT NO- 01 IA STATUTE IA708.2(6)
ASSAULT
COURT CASE ID: 06521 FECR082572
CHARGE CLASS: MISDEMEANOR CONVICTION
TRIG): 1A003L101
RESTITUTION
SENTENCE DISP EFF DAT
FINE $100 20001126
AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD
MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF
IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON-LAW
ENFORCEMENT AGENCIES BY THE DCI.
IM THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS
BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD
COVERS THE SUBJECT OF YOUR INQUIRY. *1.5
•
DIVISION OF CRIMINAL INVESTIGATION
•
elkIowa Department of Transportation
Office of Driver Services (Toll Free)8011-532-1121
PO Box 9204,Des Moines,IA 5030g-9204 515-244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 7/24/2013 DL/ID#: 959AA9537 (IA) •
Customer#: 212458
Name: Alawneh, Rafat Ahmad Class: A ID Status: VAL
Address: 1453 DICKENSON LN Audit#: 6135854 DL Status: VAL
Issue Date: 07/18/2012 CDL Status: VAL
City/State: IOWA CITY,IA 522409163 Expiration Date: 09/06/2015 CDL Cert Status: None
Endorsements: NONE CDL Med Status: None
Mailing Address: 1453 DICKENSON LN Restrictions: NONE Restriction None
Date of Birth: 9/6/1978 Supplement:
Mailing City/State: IOWA CITY,IA 522409163 Sex: M
History Information
Convictions
Citation Date Conviction Date ACD Explanation County JUR
06/08/2007 06/25/2007 1,592 Speed Johnson IA
02/29/2008 05/15/2008 —Falll_ ]ohnson -IA--
10/24/200801/02/2009 ;M14 :Fall to Obey Traffic Sign/Signal ,Johnson IA
11/15/2008 02/04/2009 ,M81 Careless Driving f3ohnson .IA
12/10/2008 .02/05/2009 ,592 'Speed Johnson IA
02/08/2010 05/13/2010 M14 Fall to Obey Traffic Sign/Signal bohnson '.IA
04/08/2011 04/20/2011 :F02 `:No Child Restraint 'Johnson IA
Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date Case Number JUR
11/09/2007_ 404T038 _ IA
02/02/2008 423667 IA
Sanctions
Type Effective __ End_ ACD Explanation ' Occurrence JUR _ JUR
Suspended 06/01/2009_ ;08/29/209 '.WO1 Habitual: Violator YIA 'IA
Name:Alawneh, Rafat Ahmad DL/ID: 959AA9537
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 ptHICIE0iN