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Home My WebLink About14-025 Authorization Number I - 2 5 1 r 1 (Office Use Only) wiz g4r, 'It AS Sig I 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 t }�n t Name � er7 — l ' L�r!ilC �� — — 2. Mailing Address C( co 3.-hp.:3) iAvenaF p--, 3f ( aivt tie , 1 cl.42,{ , 3. Telephone: Home Other: -j) _ G,, . q Z L Z 4. Prior experience in transportation of passengers: —r r4'4 s I I ;v e{1 Y'i-P (-t,i7.1,-i L,>-i t--j 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? f\(0 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? 't Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? `) Type of offense Where When IOf 1 tr 2a1 1- -ttil obty -1- (2v,‘(_ 5 ,))/1 Cil 1 t/ 1-CI1 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Ile 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 r, 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) clerl taxidrivbadg 03/2013 I hereby�oertify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number A `', _ - % 4 5-44 AC—, OA 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 Applican Cti"-ed( t/ Date (.7;9, - 0-) )L-1 STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by ,A\lierl[SN_rGrfJ;,„A p`l ,cele )1 - . On this J7 day of 7 ?1c\(\L r�r 7U/�{ . 1 11 WPv1r S >� Notary Publi in and for the Sta of Iowa 4�a"vee WENDY S.MAYS z rx Commission Number 729428 .. ;ryy Commission Expires ********i - r*** F*1 *** . *** ******k**********x*********** ***************,t*ft**,t*t***r********ir***************************************** 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). 7—lel Signa re of Peit- 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. Ji • 7\a�, 1-) q 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 5 1/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update clerk/taxidrivbadgeapp2010.doc 03/2013 1111111 Iowa Department of Transportation • Office of Driver Services (Toll Free)800-532-1121 PO Box 9204,Des MoinesIA 50308-9244 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/31/2014 DL/ID#: 544AG7008 (IA) Customer#: 5868048 Name: Abdella,Alaaeddin Class: D ID Status: None Nasreddln Elzaki Address: 950 23RD AVENUE PL Audit#: 7626874 DL Status: VAL APT 3 Issue Date: 12/19/2013 CDL Status: None City/State: CORALVILLE,IA Expiration 07/31/2016 CDL Cert None 522411291 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 950 23RD AVENUE PL 'Restrictions: NONE Restriction None APT 3 Date of Birth: 7/31/1976 Supplement: Mailing City/State: CORALVILLE,IA Sex: M 522411291 • History Information Convictions Citation Date Conviction Date ACD Explanation County 3UR 09/29/2012_.._.. 10/12/2012 S92 'Speed Johnson IA 01/22/2013 02/15/2013 .M14 Fail to Obey Traffic Sign/Signal -Johnson IA Name: Abdella,Alaaeddin Nasreddin Elzaki DL/ID: 544AG7008 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: ?EN1Clf y at?• •••••.�4 3 1/31/2014 iiti 0 ••••••'S`0 � Office of Driver Services `` UQ _ `". -I Iowa Department of Transportation Name: Abdella,Alaaeddin Nasreddin Elzaki DL/ID: 544AG7008 Ftb. 5. 2014 2:43PM Div of Criminal InvestigationNNoo. 48735/07PP. v1/2 Jan. 31. 2014 4:39PM City Clerk - City of Ion city 0 s; STATEO IOWA , 4 t IteNL)4 ,11 Checs ? v.',bVi.'.;;'1r:r9 8eWSst Form 3( l i b . F0Tv� I DCX AccouutNumber:_ N o 0 a l^ (ifapplleable) Prom: city To: XoWalliVistoriof�'SminotYttWattgatiou oflows.City Support Operations Bureau,l'tFlo or City'Clerk's 0111ce 2131.7th Street 410,D.Washington Street Deg Moines,YoWA 50319 (515)725.6066 Iowa City, IA 52240 • (515)725-6080 Fax Phone: 319356-5041 Fax: 319.356-5497 Iain requesting au Iowa Criminal Ilistoty Record Check on; - Last Name(mandatory) fret Name(mandatory) Middle Name(reeaatmended) — /kSRI DD �� L24K( Date of Birth(mnndrlory) Gender(mandatory) Social Security Number(recommended) . • 61 . 3I . 1976 .E1Male DFemale AIA 16 6s- e556 history record may be releasable, able, al'Information:Witof Iout a wa, Chatgned IVA ter 692,2.For complete crier from mof the request,a inal history record information,aslallowed by law,always be Yeloada6le,per Code of XoNa, p obtain a waiver signature f om the subject of the request. Walser Re/ease;/hereby give permission for(ha above requesting official to conduct en Iowa crIminal h(storyremrd checkwltlrtbeDiHsion of Criminal lnreatigat(on(DCD. My criminal h(stoiy data concerning nut thattsmaInulued by Ma XClmaybe to rased as allowed bylaw. Y Waiver Signature: 2, v -L ha .W 1I)b[A "p`,, • • 1Qac,LiMiLl alrifiStory'Record Check i':esu1t� (DClusean(y) • As of Z5 ( / , asearch ofthe provided name and date ofbirth revealed: c:: .67; („ r` r'n-11 o i- No Iowa Criminal History Record found with DCT V' ( pin - -4'1C7 [xl ;tJ�_ G7:?1 —0 ,10 • 9 :kw Iowa Criminal History Record attached,D CI# r r5 FY • :a. rz: N :c DCI initials_ 4b . _. :..- .a n_.--1,. 11 —9A1d— d•lAPNrNn. 9040