HomeMy WebLinkAbout14-027 Authorization Number (`�
r 1 (Office Use Only)
4uIII ti
APPLICATION FOR TAXI DRIVER
CITY OF IOWA CITY (Police Department review must be made
410 East Washington Strcct 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
—t--Name 3/41444g-1)-104 A 4L 6,44L
2. Mailing Address 2-5-2 5 c3I1/?J LT /20 -# CC`S t A 7 Z z
3. Telephone: Home 76 _- 20c. - U 1-4 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 v
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? /v'O
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? ►�"c
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) ;kJ C
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)
03/2013
PP r
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
Sq Lc A\-k LI 5—LsQ . 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) R ��
Signature of Applicant 8 __� "'^""' Date z-- 7 — 2c' L k--(
***************************************************************************************************************„...************.************.*
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to be ore me by �, C 1. �; A Ac . /klam, i, . On this `1 - day of
, -.-euur 20
�
' , < rl 0
tary u icinan�forthe to of Iowa
o`�4a14
((7,,'WENDY S. MAYER w*ITN-1
• MY C.7omm is on xp,res
I have reviewed this app i . , +CI 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).
...1- , . -7//aA//
Signature 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.
)1 sftf/L-ci-l-c.--) l' . '''"56-c/).) — ID"i il
Signe -e of City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2” (width) and 5 1/2"
(height) and prominently displayed to all passengers.
*******************************************************************.....*********************************************.**..******.*.*....., ****
Office Use Only
Approved application
DCI report
State certified driving record
Website update
clerlJtaxidrivbadgeapp2010.doc 03/2013
,Feb, 5. 2014 2:44PM Div of Criminal Investigation No. 35 PP. 2/2
• Jan. 31. 2014 4:38PM . City Clerk - City of Iowa City
i t^ }�i ' STATE OF NOWA
CICfinaT inial tatoiry lk ecorrd Cheek _re X01,Y9:..:`,Lt=d c
!F.% ?Ili!
r.aiea " Request]H'orr> 0.,,,:m". :
DCI Account Number:Th2fD
(Ifapplle° le)
To; Iowa Division of CriminalInvestigation •proan: City of Iowa City '
Support Operations Bureau,1"Floor Clty Clerk's Office
215 E.16 Street _410 E.Washington Street
Des Moines,Iowa 50319 Iowa aty, In 52240
(515)725.6066
(S15)n5-60B0 Fax
Phone: 319-356-5041
pax: 319-356-5497
I am requesting an Iowa Criminal History Record Cheek on:
Last Name(madmen) milt Name(mandator)) Middle Name(recommended)
A'LG44LI I3ANAeLD //V A
Data of Birth(mandasory) Gender(mandatory) Social Security Number(recommended) _
/U / 2 3 f t cl 1-3 arMale DEemale Q 2 `I ^ 9 i .. 17 s 9 .
LWaiverinformahion:Withouta signed waiver from the subject of the request,a complete criminal history record may not
be releasable,par Code of Iowa,Chapter 692.2.Fpr complete criminal history record information,as allowed bylaw,always
obtain a waiver signatnve from the subject of the request. .
nvtin( Sireby glvoyerrnission for tha atlofficial
ltcrkWllhlhobivklonoYCriminet
esgatio (DCI). Any crmiinalM,lo,ydataconceningmeMlam�tacdbytDC'maybe eleasedn,allow by law
Waiver Signature: L di /<'/ ' t. 4
• Iowa Criminal l ti torr Record Cheek Results • prim only)
C7s
As of 2:-.51 LI , a search of the provided name and date of birth revealed: „ `!;
m
f c;-, co t ni
n_
- c .
No Iowa Criminal History Record found with I)CI ='r) —0 Y'-T'
Cid-T1
Iowa.Criminal 1-listory Record attached,DCI# t.r N
DCI initials, 1h V,
n. - - :..- .1 T:__ I.. 91 onle d•1APIVLMn. 1040 1 c,
Iowa Department of Transportation
101) Office of Driver Services (Toll Free)860-532-1121
PO Box 9204,Des Manes,IA 50306-9204 515-244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 1/31/2014 DL/ID#: 596AH4569 (IA) Customer#: 5955498
Name: Algaall, Bahaeldin Class: D ID Status: None
Akasha
Address: 2510 BARTELT RD APT Audit#: 6994884 DL Status: VAL
1A Issue Date: 05/31/2013 CDL Status: None
City/State: IOWA CITY, IA Expiration 10/23/2017 CDL Cert None
522462716 Date: Status:
Endorsements: 3 CDL Med None
Status:
Mailing Address: 2510 BARTELT RD APT Restrictions: NONE Restriction None
1A Date of Birth: 10/23/1973 Supplement:
Mailing City/State: IOWA CITY,IA Sex: M
522462716
History Information
Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date Case Number 7UR_
01/22/2014 ;781326
Name: Algaall, Bahaeldin Akasha DL/ID: 596AH4569
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:
j 9ie1� "a
>$'. 0.%\ 1/31/2014
* IOWA 4';
sn*a.D. 0. T.A.71's
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owaaDepartme Dof Driver epartment Transportation
Name:Algaall, Bahaeldin Akasha DL/ID: 596AH4569