HomeMy WebLinkAbout13-075•1 r i
+ M�Im��1■
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826 f�
(319) 356-5040 (;q^L I—
(319)
(319) 356-5497 FAX
First
1. Name ICY /YlO h
Authorization Number I 1J
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday - Friday.)
Middle
Last
2. Mailing Address I' IowQCa- 17xi I A, F5 2244
3. Telephone: Home 9 ._� �3 -J=I O 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/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?�(r,�,
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?
Tvpe of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? NO
O
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)
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)
da WWkdrivbadg 03/2013
I hereb certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
I understand that if I falsely answer any questions in this application, that this
applications n ay 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 provi§ions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public) (\ t-1) /F\
g pp 3
Si nature of A lira \ Date®3-23_1
# # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # * # k # k # # #Y #Y #Y # * * * * * # * * # # # # # * # * # *Y # # * # # # # # # # # # # # # * # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # #Y # # # # * # # # # # # # # # * * * * * * * * *
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by Aymar, Sir v -LIE On this d7 A -1Z, day of
M _ _
Notary Public in and for the State of Iowa
**********k**k**#**kkkk*k*#kk***Mk*k#***k#*****kk#kt*#k*#**#**k#kkkk#**#***Y*#kkkk*k*#**Yk*kk#**k*kk*kk#***k***k*****kk*k**kt***kk*************
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).
Sign
/aIAe of Pp is Chie 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.
Signatu of f City Clerk or designee
3 -a /3
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and 51/2"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
cl d ddw deeappMOd. - 03/2013
JL
ARTS
Page 1 of 1
Iowa Department of Transportation
CE NM Office of Driver Services troll Free) WO -532-1121
PO Box 9204, Des Moines, IA 503DM204 515-244-9124
FAX: 515-239-1837
140
Certified Abstract of Driving Record
Inquiry Date:
3/27/2013
DL/ID #:
679AI0237 (IA)
Customer #:
6073198
Name:
Sharif, Ayman
Class:
D
ID Status:
None
ra��ti
Mahmoud Mohamed
Address:
1516 CRESCENT ST
Audit #:
6811515
DL Status:
VAL
Issue Date:
03/27/2013
CDL Status:
None
City/State:
IOWA CITY, IA
Expiration
09/18/2018
CDL Cert
None
522402137
Date;
Status:
Endorsements:
3
CDL Med
None
Status:
Mailing Address:
1516 CRESCENT ST
Restrictions:
NONE
Restriction
None
Date of Birth:
9/18/1967
Supplement:
Mailing City/State:
IOWA CIN, IA
Sex:
M
522402137
History Information
CLEAR DRIVING RECORD
Name: Sharif, Ayman Mahmoud Mohamed DL/ID: 679AI0237
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:
"""'•tib'%'4
3/27/2013
10WA ' e"W1
c4VIV
D. 0. T.
44CZXIC�
...'g'
7F S =
Office of Driver Services
ra��ti
Iowa Department of Transportation
Name: Sharif, Ayman Mahmoud Mohamed DL/ID: 679A30237
http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 3/27/2013
Mar.25. 2013 9:O1AM
mar. 15. mij 4:I1l'm
c
Div of Criminal Investigation
city clerk — City of Iowa City
8TATA OV IOWA.
(i xrlm>itngH.JHiaory.Reco>rd Check
Requesttll+orm
To; 101YJAP109lohoSCYim�`na1X4VaRf/,�gttoh
suppol'tOperafionsagraptr,l'IXIiooY
2151;. 9�h 6[reet`
,besM(ofgey,Toty& 40319
0�1s) 729.6o6d .
(g15) 92S-doBo kra�
eggostrne an.76nlx CrlmihPTRIslowpeoord Chook on:
oq 18 f9g7
iyr+dver 1�orma�rorl; p/ithoata
ho Yoleoonbrv, live Coda 6916Wp. Ch
WVA
No. 7506 P. 1
No. 3324 P. 2
0
PCTAaeounMimbor: po
appllrgp a
bYamt CITT OG IOLlA C`x
aw awla ovaox
lain Tt. 'G7ARIITN'2Th�S7.RTiCvT
107A CITErmr22-41)_,
1'IlonAf _ �19��SF�SOG.1
traxf , 319=95fi�gQ% _�.
qr7
=hixare C%arg 16 ¢
kAom lnosubJeotoPiheraqueaP, a rompJate ehlmt�Alhisfoty reenrdma)1Tot
for C01�1pT0 iQ npindnal history recorrTMfoxmai(ox, aa<aliowod SyldEr, ulPiays
neoYCYageesWg Ria/pT Ip W1f/VotW(ralVa otlminalNslosy(eoo(dthecYwiln,AeDlislon OfC,iminaf
queUln[la�a(p[�alacgl�IhoDOYmVybarolrasOdwaf(owad6yinw.
A `\
Aso 3 asearehofllaproyidednaraeanddatao#6a�4h1'avoaled I:
No Towit W- mfitaiRistoryPecord fDlla w(CiibCT
rovPa CkWulMatoi jRecord altachci, Da -A
bClfiaJffeG9.�, '
Rece_ived_Ti_ e a.[,.15.-2013— 4:13PMrNo.6695
1nl',njy,
P
�
r`:iS�J�ll
ji
7 i,A
n ��
aC1ti
PCTAaeounMimbor: po
appllrgp a
bYamt CITT OG IOLlA C`x
aw awla ovaox
lain Tt. 'G7ARIITN'2Th�S7.RTiCvT
107A CITErmr22-41)_,
1'IlonAf _ �19��SF�SOG.1
traxf , 319=95fi�gQ% _�.
qr7
=hixare C%arg 16 ¢
kAom lnosubJeotoPiheraqueaP, a rompJate ehlmt�Alhisfoty reenrdma)1Tot
for C01�1pT0 iQ npindnal history recorrTMfoxmai(ox, aa<aliowod SyldEr, ulPiays
neoYCYageesWg Ria/pT Ip W1f/VotW(ralVa otlminalNslosy(eoo(dthecYwiln,AeDlislon OfC,iminaf
queUln[la�a(p[�alacgl�IhoDOYmVybarolrasOdwaf(owad6yinw.
A `\
Aso 3 asearehofllaproyidednaraeanddatao#6a�4h1'avoaled I:
No Towit W- mfitaiRistoryPecord fDlla w(CiibCT
rovPa CkWulMatoi jRecord altachci, Da -A
bClfiaJffeG9.�, '
Rece_ived_Ti_ e a.[,.15.-2013— 4:13PMrNo.6695