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Home My WebLink About14-158 ti r Authorization Number /q—1 5 j 1 _ 1 (Office Use Only) --tea As so•ifilr 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 �( T9) 3� 56534U�* (319) 356-5497 FAX First , Middle Last r l 1. Name �.( ( /� c Ycr v j 3„ h tr}rUryk 2. Mailing Address 9 d 2- P -� Q _� p 'Z e v- A 47 S 2 2-21,4 3. Telephone: Home 1ci . 9 o o - `-1 6 ` Other: 4. Prior experience in transportation of passengers: \/ 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? n/ O Type of offense Where When 6. Have you bee convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? f b Type of Offense fn / ! Where When r V / 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? )1/6 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 ov11 �n116 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) clerk/taxidrivbadg 03/2014 I hereby certify tptiat I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number R 3 A r( 1_- cI . I understand that if I falsely answer any questions in this application, that this app ica ion 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-; { t., 1� s r.---. . Date CCC\ S Qi- YOU ,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 \� o, V� . k,1,04%,\� �ov.5,k . k,1,04%,\ V`,y�gU);. On this 6 day of Notary)ublic in and for the State of Iowa -?1.3V7 ************************************************************************************************************************************************ 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). e'// Signature of Pc "''- or designee Date YOU ARE NO 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. / .. /Date Si natu of City Clerk or designee /g• Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width)and 51/2" (height)and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update clerkltaxidrivbadgeapp2014.doc 03/2014 4 tee- - 1- ' \IL/ .., DOT vvww,iawadot.gov SMARTER I SIMPLER I CUSTOMER DRIVEN --.e._. _. . Office of Driver Services PO Box 92041 Des Moines,IA 50306-9204 Phone:515-244-9124 1800-532-1121 I Pax:515-239-1937 wvn;.Ie'wadot.gov Certified Abstract of Driving Record Inquiry Date: 8/5/2014 DL/ID #: 343AE9739 (IA) Customer#: 5515286 Name: Mudawl, Hatim Youslf Jubara Class: D ID Status: None Address: 2502 BARTELT RD APT 1D Audit#: 6263776 DL Status: VAL Issue Date: 08/31/2012 CDL Status: None City/State: IOWA CITY, IA 522462713 Expiration Date: 08/12/2014 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 2502 BARTELT RD APT 1D Restrictions: NONE Restriction None Date of Birth: 8/12/1973 Supplement: Mailing City/State: IOWA CITY, IA 522462713 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 08/24/2010 09/07/2010 592 Speed Johnson IA Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 10/05/2013 760835 IA Name: Mudawl, Hatim Yousif Jubara DL/ID: 343AE9739 . 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: uaiuei ::•V.t. ..41„ 8/5/2014 ki IOWA • td ,c;prieen4" efeteces4 :.e /,,,,I��0*** S,`/ IowaOffice Departmr Servnt of ices ansportatlon Name: Mudawl, Hatim Yousif Jubara DL/ID: 343AE9739 % Aug. 6. 2014 9: 27AM Div of Criminal Investigation No. 6429 P. 1/7 Aug. 4. 2014 12:41PM City Clerk — City of Iowa City No. 4994 P. 2 • ;;;;;i:0,,Ph, STATE OF IOWA k"(;,+, , r�rA? ,::. Criminal History Record Check • • ; + ;,. - • ?,1i‘-at-•'at= Request Form ,(.i,'.ir- DCI Account Number: `leo -"F (inapplicable) • ' To: Iowa Division of Criminal Investigation From: City of Iowa City , _ Support Operations Bureau, I'I Floor . , City Clerk's Office 215 E.7th Street 410 E.Washington Street . Des Moines,Iowa 50319 (515)725-6066 Iowa City, IA. 52240 (515)725.6030 Pax . Phone: 319-356-5041 . Far. 319-3565497 I am requesting an Iowa Criminal Ilistol 'Record Check on: • Last Name (mandator 0 Virg'Name(mandatory) Middle Name(recommended) Lot\ w1 9RTi