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Home My WebLink About15-272CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO. 15 - 272 - (Office Use Only) APPLICATION FOR TAXICAB 1 MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) fart re to calm iefe Etre "reguired" information will resulf in cdenW of fl e appl First Middle icat on T. Name (REQUIRED) Y15 a t q 2. Address (REQUIRED) z6s`Lt Rplkeds Rd APT # i a (6Wk ,tom I A '7224/t 3. Contact Information (REQUIRED) Email: baba(ngk¢em �c3tQ �wkatl-roCell Phone(3t`I)512-ib31 (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) 'j to t Q G 5 7 II ir= X 6Z ( 2Z (LG k4 b. Taxicab Business Name (REQUIRED) . Prior experience in transportation of pa 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? No Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? N b Type of offense What happened to the charge? (Circle one) Where 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? 00 Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please proaide thc�-niame(s) �' r• CIO q....�. DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATExERTIF1ED a DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE Ci-11EF RE)QEW ' You must apply for an individual Department of Criminal Investigation Report (form available upop)requesty. (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)Cn 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 G 44A 5i , h issued on 6TI2312cl>-expiring on oL I z_Z t zo t% . 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 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant rwc Date /5CL36^ 2-615 STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by rare 1' Lt �oin�caulA� on this 3o day of -1-C) 15 . � A k�°'�`+ WENbYS-MAYER tiGw.-�ti S ~�4L'�l commission Number 22s42s Notary Publi in and for the too Iowa :i f ow'Aires �X-'' l.! I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Chauffeur's license J,q-,a- 1 �13�%its Signatu— r�fPolice Chief or designee Date 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. ��Gs� �• 7CZ�ZG� Signa of City Clerk or designee r\� Office Use Only k O d Approved application f -,-73 TI DCI report State certified driving record 4:u" Website update Cn rn (C MRA>MRw6ADGP PPL52014em ded.Doc 0312015 A0-,P,7.JiUWAD0T , SMAATU I SHAP fi: 4 CUSTt7�AER GRIVEIN Office of Driver Services PO Box: 4204 I Des Moines, IA 5{3306-92D4 Phone. 51!5-2.44-912418Ofl-532-1121 Ifav 515-239-1837 wwa.lo allot gov Certified Abstract of Driving Record Inquiry Date: 10/30/2015 DL/ID #: 544AG5717 (IA) CDL Permit Class: None Customer It: 5867187 Class: D CDL Permit Issue None Date: Name: Mohammed, Faris Musa Audit #: 5999364 CDL Permit None Expiration Date: Address: 2654 ROBERTS RD APT 1B Issue Date: 05/23/2012 CDL Permit None Endorsements: Expiration Date: 02/22/2016 CDL Permit None Restrictions: City/State: IOWA CITY, IA 522462741 Endorsements: 3 ID Status: None Mailing 2654 ROBERTS RD APT 1B Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA 522462741 Supplement: CDL Permit Status: EEG City/State: Date of Birth: 2/22/1966 CDL Cert Status: None Sex: M CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Mohammed, Faris Musa DL/ID: 544AG5717 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: ;: """•:!�/'y 10/30/2015 IOWA %w, n D. 0. T.;� 7"'•.AI... 811114% Office of Driver Services ., Iowa Department of Transportation Name: Mohammed, Faris Musa DL/ID: 544AG5717 0ct.132315 3:36PNi Div of Criminal Investigation No. 61549 P. 2r2 Prm,cil, o1 lowu ally Clark QIflc- 319 3686497 10/12/2016 19: ue RL6 P.002/002 STATE OF 10VVA CriminaJ ffisrory Record. Che(,k Requeo Fora an Tovia K.o �,v,vv\ , 02-122) (9 66 Phone: 319-3356-504j Fal: —TI 9-356-5497-----_.__ __-- Check UMsle OFeafale M _ 62-�2-213� PjvOl Pel' IbfOI'lDla/i011: With _ out a signed Neniver from (he subject of the request, a comple(e criminal Ulory record /nay nol he releasable, per Code of Iowa, Chapter 692.2. Fol -cos_ nnlete criminal his(Oly record informalion, as allowed by law, ailvays Obtain 9 waiver sienarure from the cuhurl �r ih.. �..,... e... Waiver'ReiNaSe. I herby give pannission for Ilio above requesting official m condvel an iowa criminal his Ion, rccoid eheok wish 4m IN vision oforin4nel hsvesligetion INA). Any criminal Ili story data cancemiog me Ihal is meinWintd by Ille DCI may be reteascd as allowed by law n Waiver sfbljafure: Iowa leckResul€s..- r, (uCi use onllq As of a search of the provided name and date of bilih vevea&fi No luwa ('.riminal Hisinr), Record found with U(J n luwa C liminal History Recurd attached, ll('l �l 0 DO initialsDCI-77 (08/25,110) .- �- Rarpivad Tima Orf 11 701E 17 57M Nn QQ61 DC1 Account Iumbel: -0 0 �L ,� 17-- To:— 'Po: low's f)ivis(on of Criminal lnvrsllg2U°11 I4•unu City of luu'a,C`ily i tsttpp(rrt Operafinns I3 urea u, I" Fluor ' .--, .— __..-...--._..__..._.._.,..._. e In 2I.1 7 Ciip Clcrh _ Cyflice M Iles Moines, lnsra 5G'319 s, Io 4IU E, Washiu ion 5'trcel "` --�---------- --- (5I5)7},5-6066 .. (Sis) 1;5-6086 Pax _ ` _si,f,_V-----_....._.•__._---___..._. an Tovia K.o �,v,vv\ , 02-122) (9 66 Phone: 319-3356-504j Fal: —TI 9-356-5497-----_.__ __-- Check UMsle OFeafale M _ 62-�2-213� PjvOl Pel' IbfOI'lDla/i011: With _ out a signed Neniver from (he subject of the request, a comple(e criminal Ulory record /nay nol he releasable, per Code of Iowa, Chapter 692.2. Fol -cos_ nnlete criminal his(Oly record informalion, as allowed by law, ailvays Obtain 9 waiver sienarure from the cuhurl �r ih.. �..,... e... Waiver'ReiNaSe. I herby give pannission for Ilio above requesting official m condvel an iowa criminal his Ion, rccoid eheok wish 4m IN vision oforin4nel hsvesligetion INA). Any criminal Ili story data cancemiog me Ihal is meinWintd by Ille DCI may be reteascd as allowed by law n Waiver sfbljafure: Iowa leckResul€s..- r, (uCi use onllq As of a search of the provided name and date of bilih vevea&fi No luwa ('.riminal Hisinr), Record found with U(J n luwa C liminal History Recurd attached, ll('l �l 0 DO initialsDCI-77 (08/25,110) .- �- Rarpivad Tima Orf 11 701E 17 57M Nn QQ61