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HomeMy WebLinkAbout14-062 Authorization Number (1-) 1 (Office Use Only) ::III .., 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 ctie Wr er++►�ct ,�� 2. Mailing Address 2 5 2 qvt£'\ 0 Q „w4_ (i( - 67? 6 3. Telephone: Home a : 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? 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? &To Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? e Lt Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? !ti n 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) 1✓ b 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) clerk5axidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license rrimnber k LI, -j I Pr?. -2 3 •3 . 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 3c+-Lc/el®if, (} @.�p,L i10 Date o 5_ ( 3 - \ vi STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by J,,\ gA.2_,V hR• '04A.QM A.,..__, . On this 13 day of `VVq� _k ao 0-A . clota Public in and fof the State of Iowa ************************************************************************************************************************************************ 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,iti __., f-g-iy Signat re of Poll.i. • 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. - �) i . ,Q24./t,Q24./t/'� - 23 - / Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 5'/z" (height)and prominently displayed to all passengers. *********************************************************************************************** ************************************************ Office Use Only Approved application DCI report State certified driving record Website update derk/taxidrivbadgeapp2010.doc 03/2013 Iowa Department of Transportation (444 Office of Driver Services (Toll Free)300-532-1121 • PO Box 9204,Des Moines,IA 50305-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 2/19/2014 DL/ID#: 459AF2353 (IA) Customer#: 5741899 Name: Abdalla,Jalaleldin Class: D ID Status: None Rahemtalla Address: 2525 BARTELT RD APT 2A Audit#: 7035996 DL Status: VAL Issue Date: 06/13/2013 CDL Status: None City/State: IOWA CITY,IA 522462718 Expiration Date: 04/25/2015 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 2525 BARTELT RD APT 2A Restrictions: NONE Restriction None Date of Birth: 4/25/1974 Supplement: Mailing City/State: IOWA CITY, IA 522462718 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 01/28/2014 ;02/06/2014 S92 Speed Johnson =IA Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 12/08/2013 ,_..._._ ._.. .........�........_,e... ........ :..._0`773179 ..�...„. ..... ..,...,�..,.......,.:.. ......._..._ ,rTIA __s...�........._..._...,...,.... Name:Abdalla,Jalaleldin Rahemtalla DL/ID: 459AF2353 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: ,4... ti.1ftUClf-.4\ 2/19/2014 4• IOWA ?% P tr: i*0 a electoboak, rf,''�thjm k-sr ' owOffice a Departme tof Services Transportation Name:Abdalla,Jalaleldin Rahemtalla DL/ID:459AF2353 Mar. 4. 2014 9: 25AM Div of Criminal Investigation No. 4239 P. 1 Near, ¢, 2014 8:29AM lily llerk City of Iowa City No, 441g r. 2 i o i'e STAME CO IOWA ��'w' 5.0 . (l. .�,. C rnbnah &1 Vliet©ry'ReecS Checks , ' :7,y',," • r A-Ilolyf:.. rt 1t� ` rl t"` Malang Fern rann r ,: ,.' Y, :Cr DaAccountNumber: tihfb1-p (irappllcoble) To: Iowa Division of Criminal Investigation From; City of Iowa City Support OperationsDoreen,Ye Floor City Clerk's Office 215 V.71b Sfreet 410 2.Washington Street Des Moines,Iowa 50319 (51S)725-6066 Iowa City, IA 52240 (51012S-6080 Fax Phone: 319.35641M • ' Pax: 319-356-5497 Iam requesting art Iowa Criminal Histo Record Check on: Last Name(mandatory) Brat Name(mendatory) Middle Name(recommended) • Ahd.wll«. au-LA e\i. in Pn\1C M-rn 11 Date of Birth(maMaregq Gender(masdaroly) Social Security Number(recommended) q --015.'-1 V`' ' DMale Dwemale 694 - p- —‘-\ ‘ b7 Wallverinforhmllon:Without a signed waiver from thesublectofthe request,acomplete criminaltattoo,record may not be releasable,per Cade of Iowa,Chapter 692.2.For complete criminal historyrecord Information,as allowed by law,always obtain a waiver signature front the subject of the request. • WaiverReleose:/hereby glvopemdsslonfor lheabove requesting official to conduct an Yowl&tinin(Mao°.rcord chuck wklt the Division ofCrtminal Imesllgallo:iQJC)). MycdnihmlMalotydalecancensingmethatIsmalmainedbytheDCImaybereleasedesallowedbylaw. . WaiverSlgrratu>e; _ __ .. -- _ -' ,, _ _ t -=' _ . . A. - - ,_A. 0 • XQWO C>rimiinal lH igtory 1'(word Check Results (nclwe GI.'' As of 3 r 4/-- / 1.4 ,a search of the provided name and date of birth revealed: • : No Iowa Criminal •His-tory Record found with ACT 0 Iowa Olivine'History Record attached,DCI# DCT initials trec `-' Rapolva,l TQM. M2 , A 11114 A./Hann 47a