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Home My WebLink About14-195 Authorization Number 1'4 - 1 (lb I r 1 (Office Use Only) wrl®ice APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE 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 f First Middle Last 1. Name Y G� /tn.Yv1 L 1 D 2. Mailing Address 4 `", aN a_p'f' Z {074,4 el; (4 5-2,-1-9 3. Telephone: Home Other: S I _ g3 _ 1 / / 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?rV a 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? / C.3 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? N 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? v3 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) clerWtaxidrivbadg 03/2014 I hereby certitt that I,.iave isedstto me by the Iowa Department of Transportation a valid Chauffeur's license'nurnber 3 .2 1< H �S `7H . 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) 1 � Signature of Applicant Date C) 2 I —}� 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 ) n Subscribed and sworn to before me by ZIP r � cer►u. A . �l Se ec9 . On this a) 5,1-- day of 14:;)t4 . I"- 1.'58 s WENDY S.MAYER Notary Pubic in and for the State of Iowa c+it,ommisslon Number 729428 • My Comuss Expires ioiv '7-13 ****************** ********* ****************************************************************************************************** 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 welfar- of re identsof the City of Iowa City(Title 5, Chapter 2, City Code). Signat .f •.lic-°7"ief 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. `l— 3 — /G/ Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/2" (width)and 5'/2" (height) and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update clerk/taxidrivbadgeapp2014.doc 03/2014 960/ '°N Wd88 l HOt 'H. Intawi,I paAianti l01./SZ/80)a-FaQ ` Ietsnn IaQ #ZOQ`Pvtloeiitt paooag sxogslli lennurxa remor N ' • Da TIM punoW p:cooag rtIolsrfl It:uau(.to-enrol oN/ ; :paleanaa rpuq Jo alep ptlr want paprAoxd alp jo tpaaas a ' }„I jo SyI , •• (Mugpsotaoi SfnSaf 1palg3 paoaaj sworn $uIiuI.za (;JL1oI •-.� --7- y y-grynp 2 ;arnpnagaangv� uar dg pomp se pops oq Mw mc-lin tg pauieto; • �., V wiewadot.t, cv, SMARTER I SIMPLER I £USTOMEP DRIVEN Office of Driver Services PO Box 9204[Des Moines,b%50306-9204 Phone:515-244-9124(800532-1121 (Fax:515-239-1837 www-iowadot.gov Certified Abstract of Driving Record Inquiry Date: 8/19/2014 DL/ID#: 832AK9899 (IA) Customer#: 6255496 Name: Elseed,Ibrahim Awad Class: C ID Status: None Address: 2504 BARTELT RD APT 2C Audit#: 8329899 DL Status: VAL Issue Date: 08/06/2014 CDL Status: None City/State: IOWA CITY,IA 522462714 Expiration Date: 01/01/2022 CDL Cert Status: None Endorsements: NONE CDL Med Status: None Mailing Address: 2504 BARTELT RD APT 2C Restrictions: NONE Restriction None Date of Birth: 1/1/1960 Supplement: Mailing City/State: IOWA CITY, IA 522462714 Sex: M History Information CLEAR DRIVING RECORD Name: Elseed, Ibrahim Awad DL/ID: 832AK9899 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: aCIF-.4ii8/19/2014 >? IOWA ?% yD. 0.T 'e ,��f ORNEA% moi Iowa Department of Driver rtmr tervicesnsportatlon Name: Elseed, Ibrahim Awad DL/ID: 832AK9899