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Home My WebLink About14-206 Authorization Number I L1- (, - 1 (Office Use Only) Mil Ate an I igiriir 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-S497 FAX First Middle Last 1. Name(REQUIRED) /14 4isAl2, ow/ 2. Mailing Address(REQUIRED) ([o 'L kiriateaciori 'ld(_u'd --g If / /0C- ('I/tf, lif sz-z t'o 3. Contact Information (REQUIRED) Email: /(,(A 2, 2 1 C�,t,(gtL cdre t Cell Phone: 7o'( %p3 ,Z- 4. Prior experience in transportation of passengers: 'jklcj of z-i (p,Jc, C7 F-y 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /46 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? /10 T Type of Offense Where `When :7- — =-t c� a 7. Have you been convicted of any traffic offenses in the last five years? ye) _ _ Type of offense Where �etQ kYr 03/2 Z// 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? b.17) 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) N") 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) 09/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number t.iq 3 1-1 ,'g y e . 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 wwl 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 Date 4-k// 2./ I y 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 ) 1 scribe and worn to before me by 11 la ASO_CO—�1 lCI pct . On this I - day of r C )c�- 4- s KELLIE K.TUTTLE f 9 Commission Number 221819 Notary Public in and for the State of Iowa •{ M)41-- s qr) plres i(rFA I I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there ' •o info ii ation which would indicate that the issuance would be detrimental to the safety, health or welfare of r- iden = • 'ty of Iowa City(Title 5, Chapter 2,City Code). Sign..ture 'ifs" 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. k _ ,/ Signat e of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/2" (width)and 5 1/2" (height)and prominently displayed to all passengers. Office Use Only • w Approved application! DCI report;Z; -"" >'v State certified drivirig.-ec Website update ; Clerk/T'AXIDRIVBADGEAPPL92014amended.DOC 09/2014 I ) ARTS Page 1 of 1 Cti lowAD0T SMARTER I SIMPLER I CUSTOMER DRIVE v41vvvtJ,ICtvvad .C, ov Office at nrtvee Services PO Box 9204 f Des Moines,IA 50306-9204 Phone:515-244-91241800-532-1121 [Fax:515-239-1837 www.iowadot.gov Certified Abstract of Driving Record Inquiry Date: 8/21/2014 DL/ID#: 473AF1848 (IA) Customer#: 5761443 Name: Abdelrazig, Malsara Class: D ID Status: None Address: 1102 HOLLYWOOD Audit#: 6436744 DL Status: VAL BLVD APT 11 Issue Date: 11/01/2012 CDL Status: None City/State: IOWA CITY, IA Expiration 11/01/2017 CDL Cert None 522407046 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 1102 HOLLYWOOD Restrictions: NONE Restriction None BLVD APT 11 Date of Birth: 11/1/1972 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522407046 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 03/22/2013 ;05/06/2013 IS92 `Speed WI - Name:Abdelrazig, Malsara DL/ID:473AF1848 • 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: itli0p@:.......:D,�.y4 8/21/2014 �' IOWA ?o fr D. . O. T. I 0y• - of Driver Services owaDpartmetofTansportation Name:Abdelrazig, Maisara DL/ID:473AF1848 http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 8/21/2014 Sep. 5. 2014 5: 23PM Div of Criminal Investigation No. 8918 P. 2/8 Aug. to, to 1,4 z:4ornl UIty bletK - LI ly oT Iowa t.Iiy No. 5177 P. 2 0. 11,"k.- 7>SSAA A OFIOWA t31.t-(„v oh • !n� � 1� Criminal History Record • Check .i '1s• ,I0 AI •2,-' �;,.' Request Form Gkc.....--:it: . rn j DCI Account Number: !_/ to -r (if applicable) To Iowa Division of Criminal Investigation Fran: City of Iowa City Support Operntions Bureau, 1"Floor City Clerk's Office 215 B,7th Street 410 E.Washington Street Des Moines,Iowa 50319 (515)725-6066 Iowa City, TA 52240 (515)725-6080 Fax • Phone; 319-356-5041 Bax, 319-356-5497 I am requesting an Iowa Criminal History Record Check on: Last Name (mandatory) First Name(Mandatory) Middle Name(recommended) aoe -RA-7-16, MA-/SARA Motu EL iM Date of Birth(mandatory) Gender(mandatoty) Social Security Number(recommended) l\ /o i / i'1-7- NIMale °Female 61z -04 - S ( G y . Waiverl►tfOrmlilon Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 6912.For complete.criminal history record Information,as allowed by law,always . obtain a waiver signature from the subject at the request. Waiver Release:I hereby give permission for the above requesting official to conduct an Iowa criminal hinory record check with the Division of Criminal Investigation(DC1). Any criminal hbrory data concerningme that is maintained by the tiClmaybe released as allowed by lew. J • Waiver Signature: I� / / 7K- /1d�Lt/ i /Iowa Criminal History Record Check Results • (DCI Use only) As of 5---/y , a search of the provided name and date of birth revealed; .: i-4. No Iowa Criminal History Record found with DCI Y-1 i .•:,• . ce; •, EI Iowa Criminal History Record attached,DCT# DCI initials Received. Timer-Mug, 28. 0:2014 2:43PM No. 8 1 .