HomeMy WebLinkAbout14-129l
Author) tion Number I q ®'
(Office Use Only)
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
2. Mailing Address
3. Telephone: Home &;_ ®then: ��
4. prior experience in transportation of passengers: -Z..Y
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Where
B. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?0_
I & of Offense
Where
7, Have you been convicted of any traffic offenses in the last five years? tv C)
1
W=
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five y us?
Where
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
A /'
You must apply for an individual Department of Criminal Investigation Report (form available upon request).
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
aiw8c�9 03/2014
hrbX. certify that 1 have issues to me by the Iowa Department of Transportation a valid Chauffeur's license number
5 T'. Fnf::D�C, 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)
° q
Signature of Applicant Date 0 6y -
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 }
Su*ribed and sworn oto before me by �� » M� " � � "' On this l" """" day of
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).
........
.......... ...__...................................................
ordesignee I:: ate
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.
Signature of City Clerk or designee
ate
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/d' (width) and 5 %11
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
derldwddnWad„ aep'2^14.doc 03/2014
i i 1 „r ii 'iG II
rivarp of
Ceirtifiied Abstlrant of Diriving Record
Inquiry Date:
6/11/2014
DL/ID #:
BISAK6090 (IA)
Customer #z
6231198
Name:
Mohamed, Elwaleed
Class:
D
ID Sbatuw
None
Mussa
Address:
729 E 2ND AVE
Audit :
8156090
DL Status:
VAL
Issue Daaa:
06/11/2014
CDL Statum
None
City/State:
CORALVILLE, IA
Expiration
01/01/2019
CDL Cert
None
522412201
Date:
Status:
Endorsements: 3
CDL Med
None
Status:
Mailing Addresez
PO BOX 2783
Restrictions:
NONE
Restriction
None
Date of Birthz
1/1/1975
Supplement:
Mailing City/State: IOWA CITY, IA
Sam
M
522 2763
History Information
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.
r, e
th Is date:
6/11/2014
�e
Office of Dr!
Hama® Mohamed, Elwaleed Mussa DL/IW 815AK6090
IC)VNP, P
ver Services
Iowa Depart
ment of Transportation
Jun,13, 2014 10:25AM Div of Criminal Investigation
jun. II. LV 14 I,ISrnl City vierK — vity of Powa �-ILy
STATE OIN IQA
CrAmijalal History Rr r',a l gal Check
Itti ' r{ l 4 t P Form
II is
Toi Iowa Division of Criminal rinvestipflon
Floa
2,15 F" 711, Skeet
Des o ,
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No. 1742 P. 3/5
NO. 417 ( P. L/ L
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Phone"-, 319-a56-6041
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ceived Time Jun. 11, 2014 1:11PM No,