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Home My WebLink About14-132410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (3 19) 356-5497 FAX (First 1. Name ,< q— (Office Use Only) 3o Xt Cab 2. Mailing�idrfress._ 3. telephone: 4. Prior experience in transportation of passengers: _____- e". . J—. - 5. A— 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? — 6. Have you bee convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? No 7.. Have you been convicted of any traffic offenses in the last five RM 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? / /b 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provide the name(s) • •w �..� hATAIR1t (OVER FOR REQUIRED SIGNATURE AND NOTARY) tom'+ vbadg 0=014 f: y certify t I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number 1 cel that „,, I understand that if I falsely answer anv duestions 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 .4' Date ^ 4' r I.. 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. STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed LA and swo to before me by _} _e�'. On this J _ _ day of 1 n_�ttA i u-"'. tst'ku w+. AftD 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). YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERKS OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2” (width) and 51/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update V deikrta,ddr1vbadgeapp2014.doc 03/2014 Jun. 27. 2014 '1:25AM UU M. Lu. Zvi, J.UU,iV, 011 IIIlhllIq IIIIall Wlll Div of Crim nal Investigation �'Itr ',I-. h 1 LY Lit JU17; UILY STAT -E -OF IOWA cximbaR History Recqd Check Request)Formi To: Iowa Divislon of CrIminal ravestigsition Support0peradens Bureau, 1"Moor 215 P, 7"' Streaf 7.29,6066 .......................................... . .................. (5f 5.) 7WS CONG frax 0 ()V6k1 kqe2o Cbeck am tva� r Goofier RMPLIe No. 3656 P. 1/1 ku, �UVL 1 Ll t )DC1 AccounTNw-abot: _9prt h� Of mppililable) From: City CkKee office 410:1L ............... . . .. ................... T bmh 4Jty , �JAAT2 0 . . .................................................... . ............................................. ............................... .. ....................................... . .... . . . ............................................ Phone: 319 356-5041. Forx- 319-3556-4R97 UN IM irolphsoblo, per Code of Iowa, Chapter692.1. nir c kye a�k ChlmhlA h9story record ififainafloln, Agallowl.-'d bVdawn, filwnyq Walvpr.Rcleae„ i Am cky gwyo pull, imon for tAe abow a Vaqueo rag offidM to condudan 16wa eyforrind W'oory Y I cord phookAh ohKiMmian of pdwita Any r4mhul histaxy d0a coarmuhro smo fliat isviakidned by McMmaybardcnedm aliewed by Wy. lflalvgr Sigiff ature., lova C.- riminaLffbtory Record Check Rcgults (DC1 ini, only) .4.8 of ............ . ......... . ....... a S(,Rrah of the pro-Vided.iiame and data of birth revealed: Co Iowa Iowa criminal History Record attached, DC1 # . . . ........ ...... .......... R c ' 'r, e e ived 3:03PM No, 3009 gw )DC1 AccounTNw-abot: _9prt h� Of mppililable) From: City CkKee office 410:1L ............... . . .. ................... T bmh 4Jty , �JAAT2 0 . . .................................................... . ............................................. ............................... .. ....................................... . .... . . . ............................................ Phone: 319 356-5041. Forx- 319-3556-4R97 UN IM irolphsoblo, per Code of Iowa, Chapter692.1. nir c kye a�k ChlmhlA h9story record ififainafloln, Agallowl.-'d bVdawn, filwnyq Walvpr.Rcleae„ i Am cky gwyo pull, imon for tAe abow a Vaqueo rag offidM to condudan 16wa eyforrind W'oory Y I cord phookAh ohKiMmian of pdwita Any r4mhul histaxy d0a coarmuhro smo fliat isviakidned by McMmaybardcnedm aliewed by Wy. lflalvgr Sigiff ature., lova C.- riminaLffbtory Record Check Rcgults (DC1 ini, only) .4.8 of ............ . ......... . ....... a S(,Rrah of the pro-Vided.iiame and data of birth revealed: Co Iowa Iowa criminal History Record attached, DC1 # . . . ........ ...... .......... R c ' 'r, e e ived 3:03PM No, 3009 OT u ,r �w'NIc CfI�rIP l" fl� 8 IIIIII{ Vi4Mi^M4= I'GY:@�'C`„ V11111'oIl0hjt� d%V',t o a, it i M PJWiprv,lx ii Pif+u„: Va4l ats]rpui PO Box 4:.0) R EAw ,, M 6nc.:5. lA, i9)3u'ie3-:9204 Phone: 515-'244 0124 v ROG 5.32-'1127 p Sia 515 2.9--"tl S37 0rPNV.1irs°1n&o"rSCx gov Certified Abstract of IDrivi rig IReat:a:wrd Inquiry Data: 6/6/2014 DL/ID #: 582AH0582 (IA) Customer : 5930422 Name: Mohammed, Naar Class: C ID Statuso None Aldden Osman Oshar Addir'saa: 2401 BARTELT RD APT Audit 92 6081096 DL Statuso VAL 2B Issue Daft; 06/27/2012 CDL Statuso None City/State: IOWA CITY, IA Expiration 01/01/2017 CDL Cart None 522462701 - Date: Status: Endorsements: NONE CDL Ned None Status: Mailing Address. 2401 BARTELT RD APT Restrictions: NONE Restriction None 25 Date of Birtlin 1/1/1980 Supplement: Mailing City/State: IOWA CITY, IA Sam M 522462701 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: 6/612014 ,fir D. 0. T° i, Office of Driver Services Iowa Department of Transportation Namet Mohammed, Nasr Aldden Osman Daher DL/IDo 582AH0582