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Home My WebLink About14-232 (2) l Authorization Number 1 — 2 I '5 __ 1 (Office se Only) mule t1 ftt gyi mo i APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m.to 3 p.m., Monday-Friday.) 410 East Washington Street Iowa City, Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name (REQUIRED) �C,S AW, A 7 A k C)l+lko` 2. Mailing Address (REQUIRED) 1GA I titif, Nc_ A `ah bzc 6 ?)/ 3. Contact Information (REQUIRED) Email: yar)i C-A• tASAQc3► ;1-6D-A Cell Phone: 314-3f -'3 zc t 4. Prior experience in transportation of passengers: 1 ye � S 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 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? 1- 1/4- Type Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? hl C 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) Nv 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 reg}ilest). .11 (OVER FOR REQUIRED SIGNATURE AND NOTARY) ( +? -'. 09/2014 • I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 3 6-1 A C ( fit 0-3 . I understand that if I falsely answer any questions in this application, that th s 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) 1 l Signature of Applicant — � Date C I 1 6 ( LI 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. STATE OF IOWA COUNTY OF JOHNSON ) Subscribed. a d sworn to before me by yaSI i t . On this 1C day of III► /_ !C-4 `PB KELLIE K.TUTTLE )` -r' < <<'�- L (L,L �`� (� \' Commissio Number 221819 Notary Public in and for the State of Iowa n,qy�p Iss n Expuc�s �F 5 1 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). , /017(77' Signature o Pe -= a r e . designee Dat 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. • --k-47–,e-AY /e1/ ../ /fes Signature of City Clerk or designee ate 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/TAXIDRNBADGEAPPL92014amended.DOC 09/2014 r � � 5 ~ IOWAvvww,iovvadotgov SMARTER I SIMPLER I CUSTOMER OMEN S Office of Driver Services PO Box 92041 Des Moines,to 50306-9204 Phone:515-244-9124 I800-532.1121 1 Fax:515-239-1837 www.iowadot.gov Certified Abstract of Driving Record Inquiry Date: 8/27/2014 DL/ID#: 367AE1983 (IA) Customer#: 5544241 Name: Abdalla,Yasir Awad Class: D ID Status: None Address: 1141 WINCHESTER LN Audit#: 7768092 DL Status: VAL Issue Date: 02/06/2014 CDL Status: None City/State: NORTH LIBERTY, IA Expiration 02/06/2022 CDL Cert None 523179162 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 1141 WINCHESTER LN Restrictions: NONE Restriction None Date of Birth: 2/6/1970 Supplement: Mailing City/State: NORTH LIBERTY, IA Sex: M 523179162 History Information CLEAR DRIVING RECORD Name: Abdalla,Yasir Awad DL/ID: 367AE1983 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 ew, 8/27/2014 ; '�1a ,, IOWA 'y; czoi‘pip, • W3 D 0.T. :6'S gelanefflea ,, 1h' �iifUE�Ags Office of Driver Services Iowa Department of Transportation _ .? Name: Abdalla, Yasir Awad DL/ID: 367AE1983 cc ;t:g. 29. 2014 4: 26PM Div of Criminal Investigation �No. 8375 �P. 1/1 .,v b, L J, {.V I'r I V I L l r,n .,1 %, v, y I In v l S, vi 1 v Itu v l ,y I V. .1 I L V L c • /1"; 97-1.-F-4.6•'\ STATE OF 1[0W 71 �z , Ij 7w rr Top • �.lp k��o. Criminal lnal �]I>istoir�y ]macoir cChecfl� 1! 17 _ - ..:.: 'f •'•7•. •l 1 `oe;`l r, ]Request Form 5.•‹,....L.�+1', f ` '- r i DCI Account Number: off (if applical4) To: Iowa biv)sion of Criminal Investigation From: City of Iowa City Support Operations Bureau,1't Floor City Clerk's Office 215 E.7th Street 410 E.Washington Street Des Moines,Iowa 503I9 (515)725-6066 Iowa City, TA 52240 (515)725-6080 Fax , Phone; 319.56-5041 - Fax: 319-356-5497 I am requesting an Iowa criminal History Record Check on: Last Name (mandatory) First Name(mandatory) 'Arida le Name(recommended) /UDdd (I a `{ U,sir • 41,✓A ID Date of Birth(mandatory) Gender(mandatory) Soefal Security Number(recommended) O' /06 t' I R 7 1QMale ❑Female ` L 5 — 5— i 11 Waiver XnfortnatIon:Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Code of Iowa,Chnpter 692.2.Por complete criminal history record Information,as allowed by law,always obtain a waiver signature from the subject of the request. Waiver Release:I hereby give penutanlon for rho abovo requesting official to conduct an Iowa criminal history record check with the Division of aim final rfit•asligalion(DCI), Any criminal Itlelory data ooneeniingma that Is maintained by the DCI may bo released as allowed by law- Waiver signature: . 41AA.1 Iowa Criminal History Record Check Rei , (Dom°,11y) As of k`i I`-I , a search of the provided name and date of birth revealed: isi. No Iowa Criminal History Record found with DCI ;'. 0 Iowa Criminal History Record attached,DCI# • • DCI initials ._..) , 1\) Do,a ;,rod i;rrro71,7.-"')l 1C')fid 1(1•?dAM lla AllA •