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Home My WebLink About15-161=26�a �—gh ��In� CITY OF IOWA CITY 410 Fast Washington Street Iowa CLLya Iowa 52240-1826 (3191 356-5 19) 3S6.3497 FAX �sIS—i6 l Authorization Number�� f/J — r (Office Use Only) APPLICATION FOR TAXI I MOTORIZED PF-DICA13 VEHICLE DRIVER (Police Department review must be made between S a.m. to 3 p.m., Monday–Friday.) Eq- 80M —to comAleto the "required" infomratian will result Tn denial of the application First 1. Name (REQUIRED) 2. Mailing Address (REQUIRED) Last 3. Contact Information (REQUIRED) Email•R tn1aW �jp f pr+h,l. C orn Cell Phone; ` 42. 3- 7T 9 4. Prior experience In tmnsporfatton of passengers: ,]-' ,/!/weL h meo,fala tj`�ro�t f'J 7 Isor i �B �H 7 T 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? N-10 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol years?Q Q Type of Offense 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When cr+ S. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Me) 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) 0812014 I I her certfy a ve i to me by the lova Department of Transportation a valid Chauffeurs license number . E I understand that if 1 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 l YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized tax) driver names are placed on the city website at lcgov.org. I have reviewed this application, DCI report, and the State certlfled 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). _ 0 Sig Chief or designee Date 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. ign of City Clerk or City Clerk or designee ,ate Taxi cab businesses are required to provide Driver Identlflcation cards. Cards must be 8'/:" (width) and 5'/x" (height) and prominently displayed to all passengers. MltYiklr..f ww�klll4wJwiliM;YfY4yy M1w1hM11,l;MMM;aIM}M;k}hFMRMR"HAIR,YYM4I�ii11;� 1cAYr;W;Wnk{�4W FMF'Y wwixiiMiJf�;iak4#wRkHYflytlffMlp,y„R,Y R Office Use Only Approved application DCI report State certified driving record Website update C*WAwor:rranoaenPPL%214,,,sn Jox 09.2014 •sYkMllfeS41MM4Wyfl.kYilifl444;1'i NiNif N;µYi,NlntYiA;Ielei RiMA-14 kYFffYYY;RMiYIrllRl,llrfHlMMMRMIM,MIr1MMMw;_<Rwwi�yilt kYAQiI STATE OF IOWA ) p... COUNTY OF JOHNSON } on, Subscribed and sworn to before me by KtcryA)j F „ }i�t,r �f�{��_ On tiffs ' {yam Lr "^-; ay of (7 ( �'��id.4_�., �-f-••--•--.%1^57T'1,-_. '.•r... Co-? -`. _rw . vdnNnY s. —MA—YER-7 Notary Public in . for the State of l u f a�' Public in in . for the State of I u f as c•' I have reviewed this application, DCI report, and the State certlfled 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). _ 0 Sig Chief or designee Date 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. ign of City Clerk or City Clerk or designee ,ate Taxi cab businesses are required to provide Driver Identlflcation cards. Cards must be 8'/:" (width) and 5'/x" (height) and prominently displayed to all passengers. MltYiklr..f ww�klll4wJwiliM;YfY4yy M1w1hM11,l;MMM;aIM}M;k}hFMRMR"HAIR,YYM4I�ii11;� 1cAYr;W;Wnk{�4W FMF'Y wwixiiMiJf�;iak4#wRkHYflytlffMlp,y„R,Y R Office Use Only Approved application DCI report State certified driving record Website update C*WAwor:rranoaenPPL%214,,,sn Jox 09.2014 lowa.Department of Transportation ecxIdedQ;,OLx lit., es dfdj6Mrc W11-11 �` l'1Sr111'R 4M4,[307.M an%.SA+SIS:#LF-VZU, 515 2%4.9112 iAk 546 23 la Certified Abstract of Driving Record Inquiry Date: 7/30/2014 DL/ID #: 733AJ9154 (IA) Customer #: 6142527 Name: Mustafa, Kamall Clam: D ID Status: None Eldien Address: 2602 BARTELT RD Audit #: 7349572 DL Status: VAL APT IC Issue Date: 09/17/2013 COL Status: None City/State: IOWA CITY, 1A Expiration Data: 09/18/2018 CPL Cert Status: None 522462727 Endorsements: 3 CDL Med Status: None Mailing Address: 2602 BARTELT RD Restrictions: NONE Restriction None APT LC Supplement: Date of Rlrth: 9/18/1975 Mailing IOWA CITY, IA Sex: M City/State! 522462727 History Information CLEAR DRIVING RECORD Name: Mustafa, Kamall Eldlen DL/ID: 733A39154 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 hove caused my signature and the sea[ of the Department to be set upon this document, at Ankeny, Iowa this date: 7/3012014 »...a. »..*Ifalo4eZIL4 �aV+iA 's•� .. T a%IS Office of Driver Services Iowa Department of Transporation Name: MUstafa, Kamall Eldlen DL/ID: 733A]9154 Ott. 6. 2014 10:57AM Div of Criminal Investigation . Vc t, I. LV IM1 I. Z0Myl Li L Mere - b LY of toed �,I I STATE ,IOWA Criminal History rt ICheck 4) 1e, _i, To, Tows Diviatou of Criminal brVeotigation Support Operations Bamu, le Floor 215 L7aSdftt ' Des Monres, Iowa 50319 (515)725.6066 (515) 725-6080 Pax tam rnnimtffiiP m Trsmn.r1'iminAl ITia.,,ar lRncnrd C.henk on - 337 II ) P. Ll L DW000untNumber: ti 1Jfs (ifePpltoAMoi k't'oml City of Iowa City City Clerk's Office 410 S. Washhsgtme Street Iowo City, IA 53340 Phonei 319-3565041 Faxt 319-356.5497 Last Name (m Ia tpp) First Name m MidName (r=o nmmacdp Mus _d-lle ( Dat000f Cxouder n,eneua S�'o7cialSecurityklumber(mGoymao!oe d ! -( ai q i Maie Q emate tx i'* --05-- 7M (/i i Watver zr(formafwixr With out a sigead waiver from the"sgbject of the request, a complete cHinixai history r000rd may not be reltuable, per Code of Totva, Chapter 692.2. For O I citta tri mInaI history record information, as allowed by laW, ohmys obtain a waiver illgizatiato &crA the sublen of the rc uest. . WaiverRe&9We; [harchy lira pennisikn WrsAa etova repnsaing afiwiel w coedun an taws a as Y al hats y reaurd cncckydul tho nivlclon of 4in1n ae lo"tigaaen(l3p, Anyubohlel h(nory dale eaasmltgwc that is nxlnideedbytho DUmay ho relmed at allowed bylaw. WaberS4swiaree (DClesaanly) As of /Q �/_;asearchofthe provided nameand datoofbirth rereated: No Iowa Criminal flisloq Reoofd found with ACI Iowa Criminal Ristoly Rword attached, Del Rtctived Time7,Oct..,J,_o�014 9:24AM No.