HomeMy WebLinkAbout14-2241 P Jl
t `III p"
w ®®®®
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5
19) 356-5497 FAX
1. Name (REQUIRED)
Authorization Number
(Office Use Only)
APPLICATION FOR TAXI I MOTORIZED PEDICAI3 VEHICLE DRIVER
(Police Depaitment review must be made between 8 a.m. to 3 p.m., Monday — Friday.)
2. Mailing Address (REQUIRED) ae
3. Contact Information (REQUIRED)
4. Prior experience in transportation i
as mlptet6er:-'°r.aftir%ado6aPkrnarersrrn+iFlveers@Q;io-�-t ton/...... Jru.... -'tltea laratiorr
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? &J C
Type of offense
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol
years? �) 0
i
When
n7�
7. Have you been convicted of any traffic offenses in the last five years? c•t
Tvoe of offense Where When
jJ-.R..�fi".
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 027
Tyne of offense
Where
r
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)
09/2014
II her certify teat have is d to ma by the lova Department of Transportation a valid Chauffeur's license number
,._ ") y 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_ •....... " Date •? B
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.
W
STATE OF IOWA
COUNTY OF JOHNSON )ON
Subscribed and sworn to before me by On thus ✓' pec day of
n the State o ��
"k c -1 111DY s. u,rA,yrr,n Notary Public in a for � f to a `" c pa
b pCj n Nunn all
f Ayswuv'"Tr '�9u¢alla Vlr
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).
Sig d Chief or designee
l
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.
Sign a of City Clerk or designee
ate
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 W1 (width) and 5'/z"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
ClerkrrA%IDRIVEADGEAPPL92054a ,9,m] DOC 09•12014
jr110 Raj( RAW, Uas DAr0oz, 'A WX�- V114 615 244 9
Inquiry Date::
7/30/2014
DL/ID #:
733AJ9154(IA)
Customer #:
6142527
Name:
Mustafa, Kamall
Class:
D
ID Status:
None
Eldien
Address:
2602 BARTELT RD
Audit #:
7349572
DL Status:
VAL
APT 1C
Issue Date:
09/17/2013
CDL Status:
None
City/state:
IOWA CITY, IA
Expiration Date:
09/18/2018
CD4. Cert Status:
None
522462727
Endorsements:
3
CDL Med Status.
None
Mailing Address:
2602 BARTELT RD
Restrictions:
NONE
Restriction
None
APT 1C
Supplement:
Date of Birth:
9/18/1975
Mailing
IOWA CITY, IA
Sex:
M
City/State:
522462727
History Information
Name: Mustafa, Kamall Eldien DL/ID: 733A39154
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 signatur'la and the useal'. of the Department to he start upon this document, at Ankeny, llowa
this date:
7/30/2014
AN.. qun
II Y IVYn Ilfu IM W
Y Y Y PYX W.
6 b Office of Driver Services
Iowa Department of Transporation
Name¢ Mustafa, Karnali Eldien DII./ID:: 733A191.54
Ill 11 0; t, 6. 2014 10:57AM Div of Criminal Investigation No. 1331 P. 1/1
°VC t1 L ... ZVI4 7: LeMel City bierK .Clty el 10 W Cl I NU. 'l L'J7 P. L/L
01 II•
Y
Criminal History cc®ydl Check
Request Yoxxi
r
DCXAcoountN'umber: V K?FS /r=
- (iiRagririicza6xey
To: Iowa Division of Criminal Investigation Feonl: iR,g oA.yos a d dt
Support Operations Bares% I" Floor MY CIL-9 We office
215&70 treet 4101wa•shitndana'hwreei:
Des Moines, yewa 50319
(515) 725-6066 lfa rva d its„ IA 521 i0
(515)715-6080 Fax
Phone: ,119.3.56-.5041
Paw :d1.9 -356 -?'s497
1 ryamn, ra°e�,rpn�sCaal as Yor�a G.i:.rzxAGraal :Y�isiaru d:i0scolgd�'pC&Kea� can: y_� _Wn_�@q
llkngot Ka#t�ne (nn g"m1duu) �g1i/�8�.A7 `��K.� YGYW1de93J � .AW.Po.)I�WYQ9 .y,Y �RRilB" yNGC9mAlmdcd)
Date ofBirth omnaoamorA fuettGiel° lAYndasQuy)._._...... �oeisdl.�recdduxt�:i�aarnn.i7ep(:CON7parydCd
C)9 _I .:_ ( _ ale Il�lr`e1�Knre .1 5—
74
1 Lrlegep �g�drrfaao9farf„'VV ithon.ui at aIffned swoIver h -em thersotlniectofthe reolututA a coraplete cnW nal Mabry record noay soot
be releasRbleo per Code of Iowa, Chapter 6,42.2, Forgan1pleig CHM11nai histoa-,D+racora@ tuforanatIMP, as allowed by lavr, ni yr
obtain a wgalyyar sgp;aaaRake t4CgNa the sahtemk of the r�„aest.
r9'/.&8�'br!A".gR.fi.URC/lBp.o it inUNehr8IWO pCPIYEi85p4i%tQtdtp,®e1f0V6 Yl'.P1,Y.YGRCYFY QKI"aito aandmuRY41.Iowa ritiNYWenni 0=1ih(''Qh 06 nxN don ofcIXiPYinal
1n�asy�i atiel9(KACpp.A•unyoeN AWItiuiaryAMmryppn<¢67 NPour,tiyuGsrcrmiruaxnedb.Vnemt'eCimapErnr0casedasallowedley Paw,
W%Crimb1.al ffistorRecord Q;)l ed( eSUU (AClusaoniy)
As of /�% a search of the provided name and date ofhirth roi esled:
A, .No ).o a Ci:iruinaai ]Hist ,yt Recov°d found vhth gDCI
D low& Ciriniinal.:lfistoswrt ):dazttached.,.kDU#
Received Tirge710cA.-..1-,...o7014 9.24AM k