HomeMy WebLinkAbout13-095 r Authorization Number
1 (Office Use Only)
ECG
IIIb'*
~` Mlw I L
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
1. Name #f} / �t1E�r yie5Wt4
2. Mailing Address /0 `{ 1./11¢,S f Sr h r -ou%A c; g2-21p
3. Telephone: Home 3 - 6 5I- 3 Other:
4. Prior experience in transportation of passengers: 1 5 ``e.q YS _
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 4/0
0
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 /V O
7. Have you been convicted of any traffic offenses in the last five years?
T e of offense Where When
6 vet/01260o
.q<< J Ory 5 h I A oq I ;`fly/"
H5 pee �'�� �/20!2-
8. a your driver's license or chauffeur's license been suspended or revoked in the last five years.
/1/0
/0
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
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
Z2 KX rj 3j > . I understand that if I falsely answer any questions in this application, that this
application ma be dense `I underst nthat if I falsely answer any of the questions in this application, that this application will
be denied. I agree that in maki _ •'s application, I consent to allow agents or employees of the City of Iowa City, Iowa, in
their discretion, to examine . y and all records and documents relating to this application, and I further agree that, if a license
is granted, to comply at al times with all of the provis9Jrs of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public)
Signature of Applicant Date 124! 1 3
STATE OF IOWA
COUNTY OF JOHNSON )
Subscribed and sworn to before me by \��f.� \--\\4 . On this � day of
I(o ary Pub c in and for State of Iowa
713IN-
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).
Sig ture of Polic` hief 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.
- 4y
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
clerk/taxidrivbadgeapp2010.doc 03/2013
Iowa Department of Transportation
1111111 Office of Driver Services (Toll Free)800-532-1121
illIP PO Box 9204,Des Moines,IA 50305-9204 515-244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 2/26/2013 DL/ID#: 428XX5392 (IA) Customer#: 1323738
Name: Hamza, Hany Ahmed Class: D ID Status: None
Address: 1427 ABER AVE APT 5 Audit#: 4101361 DL Status: VAL
Issue Date: 02/16/2010 CDL Status: None
City/State: IOWA CITY, IA 522464730 Expiration Date: 05/23/2015 CDL Cert Status: None
Endorsements: 3 CDL Med Status: None
Mailing Address: 1427 ABER AVE APT 5 Restrictions: NONE Restriction None
Date of Birth: 5/23/1973 Supplement:
Mailing City/State: IOWA CITY, IA 522464730 Sex: M
History Information
Convictions
Citation Date Conviction Date ACD Explanation County IUR
07/22/2008 09/09/2008 _ .592 Speed 52 IA
07/22/2010 09/14/2010 M14 'Fall to Obey Traffic Sign/Signal 52 IA
10/15/2011 04/26/2012 S92 Speed 52 IA
Accidents -Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date Case Number JUR
10/22/2011 656517 '.IA
Name: Hamza, Hany Ahmed DL/ID:428XX5392
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:
Ik
o$t. o��is�,, 2/26/2013
(c:ci )
#9 ece,.,a 4e ••• Office of Driver Services
�A ` Iowa Department of Transportation
Name: Hamza, Hany Ahmed DL/ID: 428XX5392
Feb. 26. 2013 9:40AM Div of Criminal Investigation No. 4528 P. 4
• Fel. 19, 2013 12: 30PM City Clerk - City of Iowa City No. 3237 P. 2
• .
- . /01,.n'B. - /^i0 0t7 ,,1 -
tOn-
E t1,0 •. a�TATA OF IOWA � I �)'sp
.na3aI . 71,A C�Hza)SnaZ.JJ stoyRecord Cheek ;! 04FiFfa �yi'
'a. zfr c Request Form e35 e>^`,YA
PCTA000unt�Tumber: / "",2 -F
• Qhpprfcabls)
To; Iowa biv)slonofCriminalYnvastfgatrot) FtoM; ITrif e$ TOWA 071q
Stipp ort operatio❑gPireau,1e1)flooe - CITY CLERICS OVIIC1;
215E,7'1'Sin at .
benIVIOrter,To*. 50919
Cam)72s.6066 • - on. W iv: 2 t
(513)7236080 Ears :
Plionet 314•-556--51041 •
b'nx: ate--x56--5497
I Ara requesting ors loVia Criminal Moto Record Chcolc on; - .
LastN•arne(mrndatogl - PirsENamo(manddrorid ' MiddleNanOLaeontdeAdoa) '
• Data ofnirth(mrtd,lary) . Q611.der(maudgory) Social Scot7i(j/N'lnnbcr(cconnncndad)
O 51?—'31 \�� S *isle • 'emale , 3 Z G "1 6 - 11 (41
waiverlry'brHrdt/Aii;Waked as/gnod.VvaiVor*am thesubjcotottharequesi a complete orfm(nplhistory retardnlgynot
hoYMIepgable,per Code oerotrn,Chapter 69Z.&Yet,rumple fgbrIniinalItletoryreoordinl6xinatIoh,asallowed byrowtnkrnys
•--• •—• -obfash4yvatveratgnofure-nornThastrbjaotortherequest:i— --- — —' • —
TruverRefdttrorhlerai ivape,mrs,6& 0000vereques -4lofolfaeonduotazt1oVatodmtonlhhtoryeecordefietkvnit1TanwtanofComfnaI • '
Yn allget(on(pot}, rtnyor(ouhal.hraarydalit0awm(nsmomatfamatotart d6yrhedOlmey61(craw/aoflnog/6yimv.
r ,
WaverSigrature; -_ •
N�owaGrirahaaiJWstonyrRee idCheckResuttt , ' (xC)Lao only)
M of 11/W l 1.-- ,a seavek of thaprovided name and date of bl h,revoaled; ' -
No!Own CriuuualBBatoxykeeord found-Mit DCT
0 Iowa alining]2i44Reoord attached,DM*
DC.Iiniffals t . t
o. .. :•,..1 T;,...—CAL 10 --1010-11.0fPM-1)n 0hhd