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HomeMy WebLinkAbout14-109 Authorization Number 1 y— f(79. • t (Office Use Only) EEG 64 Am /PT 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 First f� Mi dlle Last -o 1. Name / D a v r 1Ot ,`' I a 1 1 & [ ket I _1 2. Mailing Address l5 2--7 / �✓ea' ("' '��- S 9-6w-a A S-2-2--(746. 3. Telephone: Home 2/5___ (00 -99 O 2 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? /V O 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? ti (j Type of Offense Where When 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? / J 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) /L - 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/tax(drivbadg 03/2014 I here certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number ,--7—) i A- c .S"1)9 . 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) t Signature of Applicant - i ( Date °7 l 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 VO, D. W, �Pr . E 1Z cQc. ,'C..i. On this t day of R`4, Notary Public in and r the State of to „00:14,,,,, ND1' Commi &MAY ssron Number 28 MY Commission Ex: ******** 7 *k**.e ),*;7** ********************************************************************************************************** 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). fel 4 Signaty4Ce o Porte •• ie 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. 74zu,�>�, . - / ,�Signae of City C Jerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width) and 51/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update clerk/taxidrivbadgeapp2014.doe 03/2014 RMay. 7. 2014 4: 11PM CDi' of uCriminalrInvestigation mllo. DP. �4/4 teuocc° • STATEOFIOWA L,"r. • �z -,� CrirmnunSSIHistoiryIRecorrdl (Check f(V ,ii; ;2ia-' I- Request r©rm m'. i; • DclAccountNumber: gQQa'( (if applicable) To: Iowa Division ofCriminal lnvestigatlon from: City of Iowa City Support Operations)11111'eau,1"Floor City Clerk's Office 215E.7th Street 410 E.Washington Street DegMolnes,Iowa 50319 (515)725-6066 Iowa City, IA 52240 (515)725-SOSO Fax Phone: 319-356-5041 Fax: 319-356-5497 • • I am requesting an Iowa Criminal llistor Record Check on: Last Name(maadalary) ]F)lt'stNanae(mandatory) Middle Name(reconmtoitdcd) etsiddldnilOaw- Ia 4b )4iic( Date of Birth (mandatory) '- gender(mandatory) Social SecurityNumbeincom mended) • o 2 — l o - t/ g reale aremale 677, / 6- _17 /1 ( . Waiver lnfovme[ioa;Without a signed waiver from iho subject of the request,a complete criminal history record may not • be releasable,per Code of Iowa,Chapter 692.1.Fpr.comuletc criminal history record information,as allowed by law,always obtain a waiver signature from the subject of the request, Waiver Release:Ihereby give permission forme abowrcqucstfng efacief to mnddct en rowa criminal h I story record check with tho Division of Crinunni • Investigation(DCI). Any ramrod historydela concendng me that Is maintained bythoDCI may De related as allowed by law, aiver Signature: i ‘ A • Iowa Criminal{.IEilistor v Record Check Resubta oftwe a,5 . As of 5-144 , a search of the provided name and date of birth revealed: ' ', co. 1, .r .No Iowa Criminal History Record found with.DCI r" : -- o.:, C . _ lv 0 Iowa Criminal History Record attached,� DCI# • Received Time May, 2. 2014 4:321'Mt o. 9062b.V= • Page 1 of 1 till 4,,,,,,w i i-ki.W" : '4 DOT • SMARTER I SIMPLER I CUSTOMER DRIVEN WUVUV Iowadat.9a .. Office of Driver Services PO Box 9204 i DeS Moines,IA 50306-9204 Phone:515-244-9124 1800-532-1121 (Fax:515-239-1837 wwwiowadot.gov Certified Abstract of Driving Record Inquiry Date: 5/2/2014 DL/ID#: 551AG0539 (IA) Customer#: 5878589 Name: Elsiddig,Moawia Class: D ID Status: None Abdalla Address: 1527 ABER AVE APT 5 Audit#: 7774806 DL Status: VAL Issue Date: 02/08/2014 CDL Status: None City/State: IOWA CITY,IA Expiration 02/10/2016 CDL Cert None 522464704 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 1527 ABER AVE APT 5 Restrictions: NONE Restriction None Date of Birth: 2/10/1981 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522464704 • History Information CLEAR DRIVING RECORD Name: Elsiddig, Moawia Abdalla DL/ID: 551AG0539 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: • /oQ.'''''. 5/2/2014 �:' IOWA :z% a c D. O. T. �g yl ,,+h s 111A OBNERc° Iowa Department eof Driver oofTransportation Name: Elsiddig, Moawia Abdalla DL/IDi 551AG0539 • 5/2/2014