HomeMy WebLinkAbout13-123 Authorization Number ' :6
r 1 (Office Use Only)
-1r4 relP•Zi EEG Aim.
4► .III,
•gt AMS gin i Air
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 4fr lV //jA �, �i�
2. Mailing Address JAZ 012 \lit.f
3. Telephone: Hone . (77P)) —444P 4/ 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 peen convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? j'; !;
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? f' )
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Al.)
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)
*Ai
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)
derkRaxidrivbadg 03/2013
I hereby kcertify thAII hav9 issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
gil . 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 •. 4/14 L))rd Date e'Avg
J
r
1 °41)*kO e N (oLt/ ),
STATE OF IOWA )
COUNTY OF JOHNSON ) /
Sub cribed and sworn t before me by /V GL- WO—— O/14 C.r . On this At day of
`et KELK.TUTT /04_,Z(ie- K /GL�'TG�
ommission LIE Number 22LE1819 Notary Public in and for the State of Iowa
I �ihra• y
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).
—ye?
Signa re of P. ic- 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.
--i
k `7c� & -q-/ 3
Signature of CityClerk or designee Date
9
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/2"(width)and 5'/2"
(height)and prominently displayed to all passengers.
************************************************************************************************************************************************
Office Use Only
Approved application
DCI report
State certified driving record
Website update
clerkftaxidrivbadgeapp2010.doc 03/2013
I's! May. 31. 2013 4: 14PM • Div of Criminal Investigation No. 5426 P. 1
• IYIay,Lo. LVID IL:JLrlrl btty l. iers — 1, 114 ul LUWd Vily Il u. 37vV F. z
•
•
,4: 1... .4) � gr OF IOWA. >; 44-, ., .
t ..../.031/1":
r • ,r LL.)rJl Record Clank li3rf ''s' i44ii1
-cV ' , Re "oxim vis p
Cr
•
DCI LfD tl _F
• • „•„,,,,,,c.,4)
•
To: XOWA nbrsfon of Cr mtnalYhtavtiXntfoh From: urn Off'SOLlA OITY •
Supp ort op bra Mos$uroau,Pro or • CAT a € s OFFlG6
215M.71hSired - 41.0 h. WAn-ToT0t7 STPRBET
bra illplges,Towa 6031.9 • .
(,els)7,x0400 o•OWA OTT? TOWA. 52.00
($15)/28-ono Bax .
Y'honop 19-7156-5W
. VoXI Dig-446-4&47
.Cam requestlnliaffoWA CrhnlnpIHlsl'o k)iecord Chadic on; ,
LetName hninaeroy) ' Rirdo',tdbrae pram ' Middle Mor o6econmenim
• Mato oThirthlompedelory) GI'ChL(Far(mmuflimp) .)"Ootiagc0Uet;Y?Alla a2'{rrommcnded)
°I ( (a1 tike alms ' temare ,g.3g -.. Z- K6 4-2.-
Wafrgr.w.o ma'ia#, ritkoutawinedwafvow*omthasuiieetofthoregpe4a complabot•Iratnihistory record nmynat
berelop9nb1esper Coda dam,Master 6fl or;ompiote erlmrnarhtstoryrecordhttninintfon,asallow a t3//mei,4C(Yays
• °Mall viedvDrairmfare gam I eubjectofthoke4liest,
WYAt/eRkeigafralacDynNe perdrtsion @rlhoobowyeq'ne.fogolTc19l(a con lad miYoWvaot6n(od throryieeo(drhec:WidlTh&)M tonotreminal
nlYasUaarlon 0)00.myodnllnehltWtyd6lga} comtngntomMUahtatnWned(yitiono maybarcTc sodas el(owcdbylely.
e
I Ong V
T'alyereri' alriYs II P
:Tom. Crimiiugz WstonyRecord Chock Roe tilts„
roClVrdon�)
Ass of i 31-• 13 ,a smolt 'titspovidednairte mnd data o btithYovenIod: ' : 1 . .
>TX lin Taws CiujinaI1iatorgizecoat food witliDCZ
El rroWa CbiminaI TO'Istoky Reoord attaohed,.b bX/
'
Received
Tim Mall. 9R. 9611 1): 41Pgga. 4390.
1 Iowa Department of Transportation
Office of Driver Services (Toll Free)800-532-1121
PO Box 9204,Des Mane ,0150306 9204 515-244-91.24
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 5/28/2013 DL/ID#: 239CC6458 (IA) Customer#: 1640461
Name: Omer, Najwa El Awad Class: D ID Status: None
Address: 322 DOUGLASS CT Audit#: 5597669 DL Status: VAL
Issue Date: 10/27/2011 CDL Status: None
City/State: IOWA CITY,IA 522465402 Expiration Date: 01/19/2014 CDL Cert Status: None
Endorsements: 3 CDL Med Status: None
Mailing Address: 322 DOUGLASS CT Restrictions: NONE Restriction None
Date of Birth: 1/19/1969 Supplement:
Mailing City/State: IOWA CITY, IA 522465402 Sex: F
History Information
Convictions
Citation Date Conviction Date ACD Explanation County IUR
07/02/2010 09/03/2010 . Improper Registration 1,52 IA
07/02/2010 09/03/2010 B64 !No Insurance Card I52 IA
y,
10/18/2011 ;01/13/2012 1E34 ,Defective Lights i52 1IA
Name: Omer, Najwa El Awad DL/ID: 239CC6458
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:
,+Ic f""m
=4. � ,'i,, 5/28/2013
At IOWA 't%
Il D. O. T.:*°
y++ of Driver
r Of QR " IowaeDepartme teces of iTransportation
Name: Omer, Najwa El Awad DL/ID: 239CC6458