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Home My WebLink About14-082 Authorization Number I a _ 1 (Office Use Only) ;,;;:i114:2%;m, 11 APPLICATION FOR TAXI 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 Middle Last 1. Name nM I LI/dL- -4L' DfA( yvl 2. Mailing Address ZLO H,R1LaIII1 AV. jCJtv/4 c_(1 9 7 `] 226 3. Telephone: Home Other: ,3/64 - 4_T7 / 0 z p 4. Prior experience in transportation of passengers: (") VI e ye4 k 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? A/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? /'\/i Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? A/L Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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) NO 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) derdtaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 4-3o H F 9 f ! 1 . 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 comp, ly_atal " - a : isions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Publ Signature of Applicantf�f ` Date -. ` - I STATE OF IOWA COUNTY OF JOHNSON ) ubscribed and sworn to before me by *cc;r Z . `Vpr z\ y; On this -& day of \'�c, -cy aQ l�{ _ Mary ublic in and for the State orlowa 1131 iy. 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). /J// ignatur 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. . ,� ////V Signasure of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width)and 5'/2" (height) and prominently displayed to all passengers. ***********#*#********************}************************************************************************************************************* Office Use Only Approved application DCI report State certified driving record Website update clerWtaxidrivbadgeapp2010.doc 03/2013 • Mar. 26. 2014 11 :35AM CDiv of Criminal Investigation NNo. 3121 PP. L1/1 :;�,; rb?i•- STATE OF IOWA -.AAPt . � � AAP • ui ..i0 .v. Criminal]history Record Check ►,.. :,A Request Form ±s;•'. .: v,.. 11' ._; (� 1. . , s. DCIAccountNmnber: 4oe _ E (it applicable) To: Iowa Division of Criminal Investigation Front City of Iowa City Support Operations Bureau,e Floor City Clerk's Office 215E.7th Street 410E.Washington Street Des Moines,Iowa 50319 (615)725-6066 Iowa City, Li 52240 _ (515)725-6080 Fax ' iI Phone; 319-3565041 Fax: 319.356.6497 . . 'I am•regnesting an Iowa Criminal History/Record Check on: Last Name(mandatory) First Name(mandalory) Middle Name(rarommended) . • AIOjel,PgIWl fiiN ( K Z /$) si l 1) Iv Date of Birth Imendotory) -Gender(mandatory) Social Security Number(recommended) • o rot? , lei 5c rzcmgo ❑Female 6 'f2 — lei. -3028 Waiver Information: Without a signed waiver from tho subject of the request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 692.2.For contort;criminal history record Information,as allowed bylaw,always obtain a waiver signature from the subject of the request. Waiver Release:I herehy give permission for the above aqua ling official to conduct an Iowa criminal histotyrceord chcekwith the Division of Criminal Investigation(DCI). Any criminal hislow dale concerning me That Is maintained by the Del may be retcascd as allowed by low. Waive; Signature: �— –AI ' Iowa Crminal History Record Check Results (Musa only) • As of 3-a.(0—_11/ , a search of the provided name and date of birth revealed: f t i -- — .).. No Iowa Criminal History Record found with DCI Co n'I fV r::i iqt 0 Iowa Criminal History Record attached,DCI# • a> -0(( f -1: • .I. c n c6 is DCI initials "=.r' N Received 'tirne7N(arn.ti.02014 3: 38PM No. 5759 - ,,,,.. i _ _ , , , ,,, DoT SMARTER I SIMPLER I CUSTOMER RIV rvv►�raca. a�vua d ot.g ov office of Di iver Services PQ Box 9294 I Des Marries,IA 59306-9204 Phone:515-244-9124 1800-532-11211 Fax:515-239-1837 W WW_i4W3dof.gov Certified Abstract of Driving Record Inquiry Date: 3/28/2014 DL/ID#: 470AF9111 (IA) Customer#: 5758262 Name: Noreldaim,Amir Zienelabdin Class: D ID Status: None Address: 240 MARIETTA AVE Audit#: 6778001 DL Status: VAL Issue Date: 03/15/2013 CDL Status: None City/State: IOWA CITY,IA 522463232 Expiration Date: 08/09/2015 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 240 MARIETTA AVE Restrictions: Corrective Lenses Restriction None Date of Birth: 8/9/1959 Supplement: Mailing City/State: IOWA CITY,IA 522463232 Sex: M History Information CLEAR DRIVING RECORD Name: Noreldalm,Amir Zienelabdin DL/ID: 470AF9111 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-EjIICIf..4, 3/28/2014 C IOWA ▪, e 'W D. O. T.. ',�' `_'▪`' owaeof Driver Department eof Trs ansportation Name: Noreldaim,Amir Zienelabdin DL/ID:470AF9111