HomeMy WebLinkAbout14-142+� ywI®rill
CITY OF IOWA C[TY
410 East Washington Stree[
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(3 19) 356-5497 FAX
1. Name
2. Mailing
Authorization Number_ )0 — /Yo2
(Office Use Only)
jown-
APPLICATION FOR TAXIIMOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
3. Telephone: Home r Other: s:1 LY 7�
4. Prior experience in transportation of passengers: 4�:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense
Where
When
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?
Where
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where
When
When
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)
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)
clerWl Mrivbadg 0312014
I hereby c rti h t y
have issued to me b the Iowa Department of Transportation a valid Chauffeur's license number
2!% 0 � � . 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 �Z
1,
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 )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by irIr\nV\.aatex-Q QQI-n)ni . On this II 1 1ti day of
. .. N.. I-1ti1
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).
' ll
Signa
turceChiefordesignee Date
YOU VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVEDEROM THE CITY
CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org.
Slgnatu of City or designee
7
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/z" (width) and 5 1/2"
(height) and prominently displayed to all passengers.
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Office Use Only
Approved application
DCI report
State certified driving record
Website update
derlJ:a.eidriatai�eapp?G14. dcc 03/2014
C410WADOT _
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Inquiry Date: 5/9/2014
Name: Ibrahim, Mohamed Elsadig
Address: 2504 BARTELT RD APT 2B
City/State: IOWA CITY, IA 522462714
Mailing Address: 2504 13ARTELT RD APT 28
Mailing City/State: IOWA CITY, IA 522462714
Convictions
Office of Driver Services
Pro Eox 92041 Des Mertes., lA 54306-55204
Prime _ 515-244-t,1241 8011 -Sq -1-1 1;L21 1 Fax 515-235-1317
ww'os..'ta gado go v
Certified Abstract of Driving Record
DL/ID #:
257OD6818 (IA)
Class:
D
Audit #:
6217135
Issue Date:
08/15/2012
Expiration Date:
09/02/2014
Endorsements:
3
Restrictions:
NONE
Date of Birth:
9/2/1979
Sex:
M
History Information
Customer #:
4350508
ID Status:
EXP
DL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
Citation Dare
Caizemiction Date
-
ACD
Explanation
coow;;y
3UK"
05/18/2012
08/28/2012
S92
,Speed
Johnson
IA
09/29/2012
11/06/2012
592
Johnson
`IA
11/27/2013
_._
;12/04/2013
_
M70
r5peed „.
=.Improper Passing
-..
i]ohnson
'.IA H
Name: Ibrahim, Mohamed Elsadig DL/ID: 257DD6818
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:
'•:�%ryi
5/9/2014
IOWA%
adp
r 081,
Office of Driver Services
oflivo
Iowa Department of Transportation
Name: Ibrahim, Mohamed Elsadig DL/ID: 257DD6818
State of Iowa
Division of Criminal Investigation
215F7"'St
Des Moines IA 50319
Ph. 515-725-6066 Fax 515-725-6080
Iowa Criminal History Record Check
Walk -In Request
Your nam
First Name Primer Nombre (mandatory)
Middle Name Segundo Nombre (recommended)
Address
Date of Birth Ferhaivacimierrto (ma,,dam y)
City/State /Zi
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_ I I " ! 1�-�- _ �. P 1 ; �,
z
Phone# r 7
C. rC� �h
11 ''-' � —
Reauestmuz an Iowa criminal history record check on:
Fill in all shaded areas.
Fast Name Apellldo (mandatory)
First Name Primer Nombre (mandatory)
Middle Name Segundo Nombre (recommended)
;ter 12i
Date of Birth Ferhaivacimierrto (ma,,dam y)
Gender Genero (mandatory)
Social Seeur!q Number (recommended)
--
❑Male ❑Female
`k ? 13 —54) 1
Waiver Signature Firma (IfLhe request is on yourself, please sign. If the requestis on someone else, write N/A.)
Results
As of 5-30- —j a name and date of birth check revealed:
ko record found
El Record attached, DCI 4
r
DCI initials
Receipt
Number of requests x S 15.00 per last name = Total amount $_
Method of payment: 1 cash ❑money order ❑check'
nrl I:RE ONLY
❑MasterCard or Visa
Cardholder's name Last 4 digits of MC or Visa
DCI initials
Credit Card Number 4 Exp. Date