The URL can be used to link to this page

Home My WebLink About13-047r ap y�®i�11 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 Q 19) 356-5040 , —(�,6 /Ytf, rCh s 19) 356-5497 FAX 1. Name Authorization Number 13 —ZO APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) Middle Last (Office Use Only) 2. Mailing Address AA4F0 `7 ffc /L�/ r-, /-# , S 2 2 c--( 3. Telephone: Home Other: 3\ Ci -2- 4. 4. Prior experience in transportation of passengers: S Yee✓ t 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When No 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? Type of offense Where When 2 GsO� 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 1/o Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using c, 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) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) d.,Wt.,dn,b.dg 09/2012 hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number i': g (f 6 N 94 . I understand that if I falsely answer any questions in this application, thaf 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) /11/� Signature of Applicant Date/ 2 S - STATE OF IOWA ) COUNTY OF JOHNSON ) ti Sescribed and sworn to before me by On this day of Notaw Public in and for the State ofTowa -'11 r r(L 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). Signat re df Po ice C of 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. Signature of City Clerk or designee Taxi cab businesses are required to provide Driver Identification cards. -fir-/3 Date aaw#4ww+##w4++wa#wwx+wow#w++wwwww++++#aw++aaa+a#+aa++a***++a++aaa+a*+w+#aaa«+aawwwwwa#*w4x*4##4#ww444#4w#4#iww##w++#wwx##w+4#Y#w#w4wwwYw#4##ww4 Office Use Only Approved application DCI report State certified driving record Website update d.rkA"d1VbedeG8PP2010.m 09/2012 State of Iowa Division of Criminal Investigation 215E7u`St Des Moines IA 50319 Ph. 515-725-6066 Fax 515-725-6080 Iowa Criminal history Record Check Walk -In Request Your name 4b d a. t4 z i z h Q u4 Address u_ tie I si Caro. (✓i 11 Ci /State/Zi a/v'/lt �2 Phone# -3 t S— Reouestine an Iowa criminal history record check on: Fill in all shaded areas. Last Name Apellido (mandatory) First Name Primer Nombre (mandatory) Middle Name Segundo Nombre (recommended) Ati a Pi, a d A b d o,,Cc, 21 -z- a ,, a. - Date of Birth Fecha Nacimiento (mandatory) Gender Genero (mandatory) Social Security Number (recommended) C>\ . 01.1 �S �( Male []Female t'ga 1,49 S5; ' Waiver Signature Firma (If the request is on yourself, please sign. If the request is on someone else, write N/A.) i aI USE ONLY Results `\� / date birth As of a name and of check revealed: �No record found 7-1 r r ` - r []Record attached, DCI # DCI initials o c, Receipt Number of requests �_ x $15.00 per last name = Total amount $ $ • OD Method of payment: Veash ❑money order ❑check # El MasterCard or Visa Cardholder's name Last 4 digits of MC or Visa DCI initials Credit Card Number # Exp. Date ARTS Pagel of2 / Na Iowa Department of Transportation CS Office of Driver Services (Toll Free) SM -532-1121 PO Box 9204, Des Wines, iA 503136-92134 515-244-9124 FAX: 515-239-1837 1*0 Certified Abstract of Driving Record Inquiry Date: 2/28/2013 DL/ID #: 153CC6499 (IA) Customer'#: 4289037 Name: Ahamad, Abdalaziz Class: D ID Status: None 03/24/2009 Omer M75 Passing School Bus _ y52 iIA , Address: 809 HUGHES ST Audit #: 6609606 DL Status: VAL ._._ _ 09/05/2010 09/15/2010 Issue Date: 01/11/2013 CDL Status: None City/State: CORALVILLE, IA Expiration 01/01/2018 CDL Cert None 522412143 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 809 HUGHES ST Restrictions: NONE Restriction None Date of Birth: 1/1/1959 Supplement: Mailing City/State: CORALVILLE, IA Sex: M 522412143 History Information Convictions Citation Date Conviction Date ACD Explanation County 3UR . . .. ..._._..._....._.._._....___..,._.__......_._... _..........._ .v._. ._....._ -592.S __....__ peed _ _._ -52 IA _ 03/24/2009 06/24/2009 M75 Passing School Bus _ y52 iIA , 02/14/2010 403/05/2010 _ S92 Speed _ >52 ._._ _ 09/05/2010 09/15/2010 _S92 Speed 52 IA I 03/07/2012 103/30/2012 ,S92 .Speed `52 ]A i Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number 3UR .____ -- 275-6—....._ 09/21/2009 X527562 4IA 07/26/2011 .640594 IIA I Name: Ahamad, Abdalaziz Omer DL/ID: 153CC6499 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 1 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: = 0p4111C1f p��q IOWA vot D. 0, T. _ 2/26/2013 http://172.29.254.55/drivers/reports/eustomerhistorylcertifieddrivingrgcord.aspx 2/28/2013