HomeMy WebLinkAbout15-078r ,
04
CITY OF IOWA CITY
410 East Washington Street
lowowa 52240-I8 6
I
CZTM) 356-5040 % 9 p
(319) 356-5497 FAX 11
1. Name (REQUIRED)
Authorization Number
,70 cob
(vmce use uniy)
APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday – Friday.)
Failure to complete the "required" information will result in denial of the application
2. Mailing Address (REQUIRED) I-
3. Contact Information (REQUIRED)
4. Prior experience in transportation of passengers:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense
Where
rn
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol o4 gs in the la�
years?. A 46
Tvoe of Offense Where --vii en - �-
7. Have you been convicted of any traffic offenses in the last five years? g
Type of offense Iheave When
IMO�Aor mL'GfS-rwa -Mo A !_I/11n If1,/ten /7>
8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years?
91
Type of offense
Where
If yes, please provide the name(s)
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND D
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FO ICE CHIEF REVIEW
You must apply for an individual Department of Criminal Investigation Report (form available upon request).
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
0912014
Sep.16. 2014 9:14AM Div of Criminal Investigation
�• SeP. 12. 2014 9:4DAM City Nl rk - City ci lowa City NNo.,0161
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Support Operafion213111,8413, V, Floor
215 E. 76 Sfveet
J) P' iMol»es, Iowa 50319 ,
(515)725-6066
(515) 725.6000 F"
T am requesting an Iowa a-iminal History Record Check on:
DCI Accorutt Nwnber, #00P ' F
(ifepPlfesbk)
From; City of lows Cit
City Cleric's Office .
brut Name, mandatory) Middle Name (reco.mnmdrd)
n10 �. W4shfn�lon Strrecr='
Towa City, JA 52�
s=
Genddeer1• (,oanderurAl Social Number (ieconmmndaf
Q D>, e) 2 , ` IQ
Phone; 3T9-356-5041 e r,
ci
F4A: 3T9-3ai65497:r-r-,
T71.
Weever �ielense thereby glVe pen4lsslon for ilia a bwo regwsting official to conduct ea lolYa crtmfnufhItIoayitcord nhcckwith lke Division ofcrfnitnel
InvesUgalion(DCf), May crimi>>Aihislorydara rnnceming ms that ism//inl��nlned bylhe bClmay be released of allowrd by law,
Well -get, Sigftallire:
Last Name (mandato)
brut Name, mandatory) Middle Name (reco.mnmdrd)
Date of Birth mm,dafory)
Genddeer1• (,oanderurAl Social Number (ieconmmndaf
Q D>, e) 2 , ` IQ
I y�4ale �k arcate (j
WliveyrlifoPIgailOJI Without a signed waiver from the subject of the request, a complete crimfnal history record may, not
be releasable, per Code of Towa, Chapter 692,2. Ford n� Mete criminal history record information, as allowed by law, always
obfainawaiver sl naturefrom the sub•eefofthe re pest..
Weever �ielense thereby glVe pen4lsslon for ilia a bwo regwsting official to conduct ea lolYa crtmfnufhItIoayitcord nhcckwith lke Division ofcrfnitnel
InvesUgalion(DCf), May crimi>>Aihislorydara rnnceming ms that ism//inl��nlned bylhe bClmay be released of allowrd by law,
Well -get, Sigftallire:
Ewa Criminal History Record Check Results175,
As of a search of the provided name and date of birth zetrealed; r
No Iowa Criminal History Record found with DCI
Iowa Criminal History Record attached, DCI #
DCI
RPCP.iYPd Time neo.19.„2014 9:39AM No.
DOT
wvinviowadotgov
SMARTER ISIPA FUR ICUSTOMEADRIVEN�,���n., ��_ _...."..
Inquiry Date: 9/25/2014
Name: Hamad, Mogahetl Mohamed
Alhassa
Address: 2654 ROBERTS RD APT 2B
City/State: IOWA CITY, IA 522462741
Mailing Address: 2654 ROBERTS RD All 21
Mailing City/State: IOWA CITY, IA 522462741
Convictions
Office of Driver Services
Fn 7ov 9204 Des Moines, IA 50'06-9204
hon,?. 515-244-9124 ( a00-"32-1121 1 Fa;c 515-239-1337
vVIVira eIvitadot:gtsv
Certified Abstract of Driving Record
DL/ID #:
241AD4645 (IA)
Customer #:
5400638
Class:
❑
ID Status:
None
Audit #:
7202303
DL Status:
VAL
Issue Date:
08/02/2013
CDL Status:
None
Expiration Date:
08/02/2018
CDL Cert Status:
None
Endorsements:
3
CDL Med Status:
None
Restrictions:
NONE
Restriction
None
Date of Birth:
8/2/1980
Supplement:
Sex:
M
History Information
Citation Data _
- Conviction Date _
ACD Explanation
County
JUR
10/21/2011
12/04/2011
Ilmproper Registration
-UP,
,IA
01/29/2013
03/05/2013
592 ISpeed -
Johnson
6A
Name: Hamad, Mogahetl Mohamed Alhassa DL/ID: 241AD4545
Pursuant to Iowa Cade §321.10, 1, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I am the custodian
of the retards 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.
IOWA
D. 0. T.
Name: Hamad, Mogahed Mohamed Alhassa DL/ID: 241AD4645
9/25/2014
Office of Driver Services
Iowa Department of Transportation
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