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Home My WebLink About14-193 Authorization Number 14— I9? � _ 1 (Office Use Only) A 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 Fist Middle La 1. Name `g 41,44 iv wt Z - zc�ZT�t 2. Mailing Address At,6a. fLob,�Y71S get #,A.G Jo;,�JGc l'�' r 1 A 3. Telephone: Home Other: 9 I (644— g ' 4. Prior experience in transportation of passengers: 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? r1//.4 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? /1/74 Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 4/70 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) /Wit 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) derkltaxidrivbadg 03/2014 I hereby certify t at I hpve issued to me by the Iowa Department of Transportation a valid Chauffeur's license number (r)t q ; i(l a 4.l 6 . 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) Signature of Applicant ,( i'l,� ,wy(' //tato'- 21'--- Date +b _ q_ 9 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 and sworn to before me by fY ,`�,� �UJ (�bi, Ncw4.-t.c . On this ��-t- day of Ac Li S fin! UJ ' LL( c)...-41.--/--- Public in arfor the State of I a i s NDY ER iA 7 Comm,ssion u ber 72rMaT234 RI Number 7?9428 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). \ lit --' 6(7,-- 5 - ick - (---C Signature of Police Chief 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. 7) lie ori' e - 7 i� 1 - , 1 — / Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/2" (width)and 51/2" (height)and prominently displayed to all passengers. **************....*.*.*.***..*.....********************************************************.*.****..******************************************* Office Use Only Approved application DCI report State certified driving record Website update clerkftaxidrivbadgeapp2014.doc 03/2014 )Aue. 27. 2014 4: 29PM Div of Criminal �Investigatio� NNo. 8683 PP . 1/1 4mti• STATE OF IOWA XtTvg , . ` : y % Crefarkuinal History Recan° ll Check _frolmu al st , F � Request Form- w a \'=-Q; , 7 • c ` 0 • • • D CI Account Number: y 0 nol '� (itepplicabic) To: Iowa Division of Criminal Investigation From: City of Iowa City • Support Operations Bureau, 1"Floor City Clerk's Office 215 E.7th Street 410 F.Washington Street Des Moines,Iowa 50319 . (515)125.6066 Iowa City, IA 52240 (515)725-6080 Fax . Phone; 319-356-5041 • F,ax: 319-356-5497 • I am requesting an Iowa Criminal History Record Check on: . Last Name(nmndarcy) First Name(mandatory) Middle Name(reconmsended) flew^ --a lip ttawfinel Z. Date of Birth(mandatory) Gender(mandatory) Social Security Number(recommended) DQ;/411g $4 d`Male lIFemale 634-a7- 2410 •Waiver Information:Without n signed waiver from the subject of the request,a complete criminal history record may not • be releasable,per Code Wows,chapter 692.2.For complete criminal history record Information,as allowed by law,always ' obtain!a waiver signature from the subject of the request. Waiver.Ra(Baser!hereby give permission for the above requestin official to conduct ah Iowa criminal historyrecord cheek With the;Diyision oftdminai •invesfgellasi(DC]). Any criminal history dam coneemingma that is mai fined by ihoMCI may be released es allowed by law, .ns¢'' .• Waiver Signature:_radt Ilea-4a £o'-'-e� /14 Iowa Criminal JEIistory Record Check Results, . l// ,(DCltrpnly) As of tS > 1' (LI- , A search of the provided name and date of birth revealed: -,••. No Iowa Criminal History Record found with DCI El Iowa Criminal History Record atta}chheed,DCI#• IN DCI initials ca Received TimerAug.TPC2014 2:38PM No, 7810 • ARTS Page 1 of 1 VIA MJ,IOwadotgov SMARTER C SIMPLER I CUSTOMER DRIVEN Office of Driver Services PO Box 9204 I Des Moines,IA.503064244 Phone_515-244-9124 1800-532-1121 I Fait:515-239-1837 • wwwiowadoLgav Certified Abstract of Driving Record Inquiry Date: 8/29/2014 DL/ID#: 609AH2996 (IA) Customer#: 5989009 Name: Hamza, Mohammed Class: D ID Status: None Zalelabdan Address: 2652 ROBERTS RD APT Audit#: 8382337 DL Status: VAL 2C Issue Date: 08/22/2014 CDL Status: None City/State: IOWA CITY,IA Expiration 03/14/2017 CDL Cert None 522462740 Date: Status: Endorsements: 2 CDL Med None Status: Mailing Address: 2652 ROBERTS RD APT Restrictions: NONE Restriction None 2C Date of Birth: 3/14/1984 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522462740 History Information CLEAR DRIVING RECORD • Name: Hamza,Mohammed Zalelabdan DL/ID: 609AH2996 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: pENICtf p ''' —`p0;•• il��y� 8/29/2014 30' IOWA t: g. =.D• . O. T. ielLetzak ,,,,1 lite/OBIVER$.f Officeof Driver erviiesIowa Transportation Name: Hamza, Mohammed Zalelabdan DL/ID: 609AH2996 8/29/2014