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Home My WebLink About13-097 Authorization Number ) 3 ` 9 7 1 (Office Use Only) 4:7%Iligh; ,I .5. soon I cliagilr APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (Police Department review must be made 410 East Washington Stied between 8 a.m.to 3 p.m., Monday-Friday.) Iowa Cit , Iowa 52240- 19) 2240-19) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name �`[ (�^ �n )i i ill Li b 4-v-ti.- Vi{� 2. Mailing Address 2 5 6 �(��- (-k-• � _2 4 f p _Co `-t` C-s ] 2,2(96 3. Telephone: Home 3 I c,t t , t,d 7 `i 6 I Other: 4. Prior experience in transportation of passengers: 5' )/ c v 7 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /v O 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? NO Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? lO O Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? -t O 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) /V O 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) derk/taxidrivbadg 03/2013 hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license numbs. 3 ? P,E 9.7 3 LA . 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 ; (1-\ YNNti d o -\ Date 5 9 n 3/ 3 STATE OF IOWA ) COUNTY OF JOHNSON ) / n' l / Sub •e+ and sworn to before me by �T' 2nL( Gt C�Lv r On this day of ' J, . E t --C. e /, ..„_ /--/-/, R! KELLIE K.TUTTL€. , Notary Public in and for the State of Iowa o...., commis My •C miss•ion Ex•ires ********************************k)4k44*ru***ww* *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). .,,////,..______---- - Signature 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. /1 �p--eW rc ' SAA-- Signa re 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 derkflaxidrivbadgeapp2Olodoc 03/2013 Authorization Number t1 (Office Use Only) t® �� O Q✓ 4► � r,w a„ jj �� v)t-YRJtIs- 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 Cit . Iowa 52240-1826_ 19) 356-5040 L 5/' (3I9) 356-5497 FAX First Middle , Last 1. Name W i ,`['{ n„ % v5I I L/ off-- 1"nUd-(A_ 4�\ 2. Mailing Address 2S 62 (,`i—`-,L L. 4 f Q _Co `"i` c-4-- y t 24t)6 3. Telephone: Home 31 y GiNt g c16, ( Other: 4. Prior experience in transportation of passengers: 3 y e._„,Th 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /' 0 Type of offenseWhere When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five /V0 0 years? No Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? t� O Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? V Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different n IOWA USA. , DRIVER LICENSE j MUDAWI DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) I 14ATIM YouslF JUBARA DRIVING RECORD MUST ACCOMPANY THIS APPLICA 2502 BARTELT RDAPT iD ,� IOWA CITY,IA 52246 '' You must apply for an individual Department of Criminal Investigatic DL No.343AE9739 .,. Iss 08/31!2012 EXP 2014.' .oq (OVER FOR REQUIRED SIGNATURE sex' ClassD End 3 Hgt 5' RestrictionsNONE - . • Eyes BRO , DOB 08112/1973 MED ALERT.Y DO 76263T763MH1050M120814D de iutaxdrivbadg 03/2013 • Iowa Department of Transportation 4� Office of Driver Services (Toll Free)800-532-1121 NI PO Box 9204,Des Moines,IA 50306-9204 515-244-9124 FAR:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 4/26/2013 DL/ID#: 343AE9739 (IA) Customer#: 5515286 Name: Mudawi, Hatim Yousif Class: D ID Status: None Jubara Address: 2502 BARTELT RD APT Audit#: 6263776 DL Status: VAL 1D Issue Date: 08/31/2012 CDL Status: None City/State: IOWA CITY, IA Expiration 08/12/2014 CDL Cert None 522462713 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 2502 BARTELT RD APT Restrictions: NONE Restriction None 1D Date of Birth: 8/12/1973 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522462713 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 08/24/2010 09/07/2010 592 Speed 52 IA Name: Mudawi, Hatim Yousif Jubara DL/ID: 343AE9739 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: 1ptWCIf/" ,i;S• /8., 4/26//013 4 IOWA ';;* �" Wit. O. O. T.: w!, ,,,Ii,�Of wn, 9D34. Iowiceof Driver a oepartme DepartmentServices ansportation Name: Mudawi, Hatim Yousif Jubara DL/ID: 343AE9739 •ti May. 3. 2013 11 : 32AM Div of Criminal Investigation No. 2208 P. 1 NH. tu. [ui3 vr)n :' V .,i (y blierK - b] ly of Iowa U fy i Ivo. 39AI r. L , Y . _ 1 . • t}^ , ,r. , (le STAT ®P'ZGWA ,C40;0t3 N\ ,�„_. �ovid- 'N Crin inaa.JB stoty�Recorra Cheek 'oe -°�f.;;� ., • o,. , i-�a:,��ic�Via'• • . • DCIA.acountNumber: a -� ' . ' Q£eppli'cabtO 1'o; XomnbIvl91onofCriminal mvostlggt(on From6 CTT?: OM IOWA CI'& 4 • • . Support Op era lions l3ueoau,iir.Vlaor 'cut 4GB$K°S ogyxo • • 215E.1filMeat 410 TS.. V/ASH1g1,9 ON'STREEETT _, . Uost phtos,Xowa SONI9 015)13g-00 • IOWA ern TOW& 57240 . •01$12 -dila° Vat . • l'hona; 919-956-5041 • 17aX4 91q—a56•-5497 . 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NCtaroon(y) As of. 9 3-13 s a search ofthoprovidedname and date o1'bi thxeve'alodl ' - . 1 •> ' ktoXbwaCrimhutLHHaatozy.kecord#'a>tndwithDCT Xowl%CahttfnalXTlstoryRecord attached,DCI:# XIC1"Spiifsls V Received_„T;me-Ap,r. 26. --2013- 2:44PM-No. 1467