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Home My WebLink About14-050 Authorization Number l J — 3-0 1 (Office Use Only) stegualy 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 F' st / 1 dle/ // Last i 1. Name /Aldi i ��c;jar 1 i. ACX //a t7 frcz��kOD 2. Mailing Address 24 0.1 142-$7c DY (=Wek, (Lit/4 .k 52240 3. Telephone: Home .3i/ t42/ 73 Other: 4. Prior experience in transportation of passengers: 2 'a iC 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Ain 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'? A/0 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? A/C) 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) cler dtaxidrivbadg 03/2013 I hereby certifyt at hay.. issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 6/ 5 41-1312c1 . 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 OPPDate /3/LA ii STATE OF IOWA COUNTY OF JOHNSON ) \*. bscribed and sworn to before me by 't v c,, S \c kA1c., Pkb dr vbbo . On this day of • V Gc.Cv Notary_Pu i *c in and for the State of Iowa 7131t' t 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). Signa Ie of P.rc: 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. 3 Signature of City Clerk 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 derk/taxidrivbadgeapp2010.doc 03/2013 j OF PUB State of Iowa ..N2s ar.ow;, /1GAJ• Division of Criminal Investigation 5� . "y, . /y¢')(t�J '� '��, 215E 7t"St --. 05;.1 + �„ °, .3 I c t IOWA I \ill Des Moines IA 50319 d= ` ""'#1":` eft t_‘41.? Ph.515-725-6066 Fax 515-725-6080 GSA o� f�91 qy', J Fo• �a.`.. Q AIMINN,' ��!rdN A�� Iowa Criminal History Record Check t Walk-In Request Your name /C/1"0 �rcthbl0 Address 1,4,-,1 lak,67,- e ri Rig City/State/Zip ,t- 't .tq 7;a• 52240 Fill in all shaded areas. Phone# 3 fci 62/ Z7r3 Requesting an Iowa criminal history record check on: Last Name Apellido(mandatory) First Name Primer Nombre(mandatory) Middle Name Segundo Nombre(recommended) A\C( ab3 A/Lua2 satab A6duQx Date of Birth Fecha Nacimiento(mandatory) Gender Genero(mandatory) Social Security Number(recommended) 01/ ' a l r Fig 6 ESIale ❑Female 733— 07 — 6346 Waiver Signature Firma(If the request is on yourself,please sign. If the request is on someone else,write N/A.) Results DCI USE ONLY As of 3 (3/01 , a name and date of birth check revealed: No record found ❑Record attached,DCI# AC-- DCI initials A-- Receiptc..,c ' Number of requests , x $15.00 per last name=Total amount$ 15. d5— Method of payment: Ocash ❑money order ❑check# MasterCardlqfor Visa Cardholder's name � � 3 5 a-t"` LL'titi�x vv�t l( 2= Last 4 digits of MC or Visa f siS(co RlS,3u DCI initials -- Credit Card Number# Exp. Date 41 i ,---.±. ..0 , 1_ , 4 .. f'oi 31 SMARTER I SIMPLER I CUSTOMER DRIVEN - 4 ----V'l01iWc'1. C�O .gov I - Office of Driver Services PO Box 9204 I Des Moines,IA 54308-9204 Phone:515-244-91241800-532-11211 Fax:515-239-1837 www iowadotgov Certified Abstract of Driving Record Inquiry Date: 2/25/2014 DL/ID#: 618AF13129(IA) Customer#: 5996818 Name: Abdrabbo,Muaz Salah Class: D ID Status: None Abdulla Address: 2601 LAKESIDE DR APT 9 Audit#: 6315715 DL Status: VAL Issue Date: 09/20/2012 CDL Status: None City/State: IOWA CITY,IA 522406816 Expiration Date: 01/01/2017 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 2601 LAKESIDE DR APT 9 Restrictions: NONE Restriction None Date of Birth: 1/1/1985 Supplement: Mailing City/State:IOWA CITY,IA 522406816 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation - County JUR 12/08/2012 _ _:12/21/2012 __JF66_ Unsafe condition of vehicle(no specified component) _ _ -IL _ . 09/20/2013 ,10/17/2013 N04 ;Fail to Yield to Emergency Vehicle Johnson IA Name:Abdrabbo, Muaz Salah Abdulla DL/ID:618AH3129 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: cFbICLf.4 ee** •:e.rtli 2/25/2014 0'4IOWA'/ 1,'h�,c,),I •''%J Office of Driver Services py➢ NEAc- Iowa Department of Transportation Name:Abdrabbo,Muaz Salah Abdulla DL/ID:618AH3129 I