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Home My WebLink About15-076• rrll®,�� CITY OF IOWA CITY IDENTIFICATION NO. S 'Q7(F•, (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday) 410 East Washington Street juvva Cit Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application (319) 356-5040 Name (REQUIRED) Middle i"Arv1C0 2. Address (REQUIRED) ZSG{O &Gt r FPJ� 12� 1L �d V.ra �1 %,\ `-�i� � 22q 3. Contact Information (REQUIRED) Email: �� i hq.h ed n �he�maiV -C� Cell Phone:(,3Iq (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) fO.o2 f . �26 / � b_ Taxicab Business Name (REQUIRED)_ C-\ n 5. Prior experience in transportation of passengers: -Q:j y-;Me-jC G� rL1 Kl Cc >� fy V -Cf - 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? M) Type of offense Where What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense nf- 0 What happened to the charge? (Circle one) Where -.sq v Other When Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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) ,1/J 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). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 5 d1 f 6 S issued on 0 .2 • I expiring on IC7 of L aQl 4 I understand that if I falsely answer any questions in this application, that this application may 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 authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of Title ,nChapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date O f S^ STATE OF IOWA ) COUNTY OF JOHNSON ) (( / l Sub�q ibed a %% d sworn to before me by 1�^� / 1[< ��7/ /7 /l /y on thisday of FI_LIE K TUTTLE ..,.,, otary Public in and for the State of Iowa 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). SignaturereerChlef or designee Da AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. THE EFFECTIVE DATE WILL MATCH THE CHAUFFEUR'S LICENSE EXPIRATION IF LESS THAN A YEAR. Signature of City Clerk or designee Date Office Use Only APR 0 2 2015 Approved application DCI report City uc: r State certified driving record IOv'a City. 60 Website update cierur IDavanocEAPPL92014arzi�rld d.DOC 0212015 Page 1 of 1 iUWADOT SMARTER € SWa'a._.. 1 CU TO Nlf , �i fif?ico of Driv'r .Services. PO Boz' 174 i Elias Midnes, IA 5030642;.4 Phone- ~.15-244-91124 1 =00.,32-1121 1 Fl . 51 23'9 13311 :Mora.io';adD'9ov Certified Abstract of Driving Record Inquiry Date: 3/25/2015 Name: Ali, Shihabedin CDL Cert Mohamed Address: 2540 BARTELT RD APT CDL Med 1C City/State: IOWA CITY, IA Restriction 522462723 DL/ID #: 435AA6105(IA) Class: D Audit #: 8210397 Issue Date: 06/28/2014 Expiration 10/21/2019 Date: Endorsements: 3 Mailing Address: 2540 BARTELT RD APT Restrictions: NONE 1C Date of Birth: 10/21/1961 Mailing City/State: IOWA CITY, IA Sex: M 522462723 History Information CLEAR DRIVING RECORD Name: Ali, Shihabedin Mohamed DL/ID: 435AA6105 Customer #: 3940416 ID Status: None DL Status: VAL CDL Status: None CDL Cert None Status: CDL Med None Status: Restriction None Supplement: 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: ...... Z`/4'� ,3/25/2015 IOWA _4yu D.0. T. pr S q� �—� Office of Driver Services Office Iowa Department of Transportation Name: All, Shihabedin Mohamed DL/ID: 43SAA6105 APR 0 2 2015 C,'.Y ( err, City I 3/25/2015 Vlar.27. 2015 2:35PM Div of CtlriinaI I n v e s t i g a,t l o n No. 3632 P. 8/8 M1r:26. 2015 12:34N City Cler! — City o1 f0wa City ND. 5758 P. 2 STATER ON 13 WA (crrWnM Monty Recol °dl (check Rvgj cgg Form, 'lo; Iowa 1Divrsdon of Crlminai Ynvestigat(on Support Cperafloas tlureau, V'Fioos- 215 )i, 71, Street D*S M0I11es,1o1va 503" (515) 925-6066 (515) 725.6090 Fa! an 7olva c3Iminal Chezk DCIAccoutntNuwW: `-bb2—� (If 8pplloable) k4''om; CiE of Iowa Ctt City Clerkls Offiec 41.0 E. Washin ton Street $owa Clty, Y A 62200 !'honei 319-356-5041 Fax; 319-356-5497 APP, 02�1015 Last NAn1e (n,suddo q) I Mrst Name (Lm/anda7mJ 'r 1111ildleName (recompnl(Pendedl F� der mardmory) I SOclalSeclitityNnimber(recomm ®bale ElFewale 1 '.7 G , 7G — 6 g s-6 WaivePlnfoPmadPon, Wilhout a signed walVtY from thesubjectof the request, a complete criminal hlslory record may not he releasable, per Code of Iowa, Chapter 692.2.Forcom lef cYlminaihistmyrec�rdlnfmmatron,asaHowedbylaw,always it�ef .eLL'iC. a.S�: Y hcrcby glva pcnn is=ivn Por the above reQues(ingotfcdol io conduct an 1'mva criminal hlslory record check arilh she Division oPCrinlinal fnverligolion (DCl), Any trlmfnnl hlslory data concerningmalbat ds Iained by lhoA0l may by reieaaed as allowed bylaw. Waiveyr,SYgnature: gown C1riimiiidll HiStOrV Record (Check ]Results cacluaao�iy) As of 3 a a search of the provldedname and data of birth revealed: No Iowa Criminal M,?tory Record found withDCI ® Iowa Criminal HistozyRecardattached, DCi# DO initials_ Received Time7Mar,26.);2015 12:29PM No -3800