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CITY OF IOWA CITY
(Police
410 East Washington Street
lows Ofy. Iowa 52240-1826
Failure
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(319) 356-5040
(3 191 356-5497 FAX
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1. Name (REQUIRED)
2. Address (REOUIRED
t -tom
]CATION FOR TE
Ltment review mi
IDENTIFICATION NO. f LJ2
(Office Use Only)
ca-�
3=5 ORIZED PEDICAS VEHICLE DRIVER
made between 8 a.m, to 3 p -m., Monday – Friday)
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First i
3 Contact Informatic r (REQUIRED) Email: b ICU( 71 a C–iy/1c(�-
(All written communication sent via E
4a. Chauffeur's License expiration date (REQUIRED) b Q ZG 2
b. Taxicab Business Name (REQUIRED) A rn +Sr-Cc,-n� 7a
5. Prior experience in transportation of passengers q P ear- S
Last}
Cell Phone- Z 3
na
sr
6. Have you ever been arrested /charged with any misdemeanors andlor felonies in this State�or else*re?
Type of offense Where
f\ . . . . Whan
23
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Z,z 1 J. r M•.t t
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty
Have you been arrested / charged with any traffic offenses in the last five years?
Type of offense 'Ar K"+'I ere �—
sr"d„ s-Off
3ekken c
spu
ned to the charge? (Circle one) 3w" CIS
Convicted Dismissed Deferred
Other
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When vivad
S•241 -i, rv(rv( 7te4
7. q.Z-,i Pond
I. ia.ay.� Pima
r( -1e,260 c.Adtcted
Suspended Plead Guilty Other
8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years?
Type of offense Where
When
an.. rnevt
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
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DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHfEF REVIEW
You must apply for an individual Department of Criminal Investigation Report (form available upon request).
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)
0212015
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
2—J 1 611 'j -
G{ 2/ _ +nF rhat I 'Cave issued to me dry the Icwa Departmelnt of Transportation a valid Chauffeur's license number
3J I1 LGj �j sued on 1�,.L� expiring on G Zai . 1 understand that if I
falsely answe, dry questions In ml5 -vj,,,clwon, 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 oxamine any and all records and
documents relating to this application, and I further agree that, if ardhorv_ation to be a taxicab driver is granted, to comply at all
times with all of the provisions of Title 5, Ch_apter22off the City Code. (Needs to be signed in (front of a Notary Public)
Signature of Applicant Date U l I J
kk*k*k*a*xkiyk#kxxkxxi.rwAAk;}*Fkkx+xk'Ak;k}XkF#RxxWMxaxkk#4kvk4h'kkFkkkkxxxwkkk*kF'kkAAAAa;♦r#A#3A{AA4[f.+WWgq#kk}xkxks}py%kkx#xxk;k*k*kkkxF;k4*kkx
STATE OF IOWA )
COUNTYOFJOHNSCN )
Subscribed and sworn to before me by \' oh y
°ao I �• �c�k , q hltric �� on this da of
11 t 1t n
in and for the State bf towa r
11
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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 he 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 1 2
Signature ofotic Ch' f or designee
2
Date
0
AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IWM C" F011
MORE THAN ONE YEAR FROM THE DATE LISTED BELOW, c�
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Signature of City Clerk or designee to =;
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Office Use only
Approved application
DCI report
State Certified driving record
Website update
ClerrlTAXlCinme,4pr3�^cppr5lU 14nn x* nh2DOc
0312015
CA
Iowa Department of Transportation
Wce of7D3rtf seryace;s { idl Fier) H00 -532-t tai
SCJ Lictx ii204MY",, boMY", u\ 53Ir'�C.
.3$2M 515�244.3124
F:+JC7 & 23J• f8 i7
Certified Abstract of Driving Record
Inquiry Date:
8/19/20!5
DL(ID #:
43SAF8256(IAi
Name;
Mohammed,
Class:
p
VAL
Barakat rage,/
S92
CDL Status:
Address:
1287 SWISHER ST
Audit #:
8331490
None
lEt0 2014
Issue Date:
02/10/2015
city/State:
IOWA CITY, IA,
Expiration Date:
05/10/2023
None
522451597
Supplement:
^'
Endorsements:
3
Mailing Address:
PC BOX 342
Restrictions:
NGNL
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cn
Date of Birth:
6/10/19/1
Malting
City/State:
IOWA CITY, IA
522440342
Sex:
M
History Information
Convictions
Customer #:
5626613
ID Status:
None
05;'012012
992
DL Status:
VAL
07/25/2012
06/13'2oL4
S92
CDL Status:
None
592
5 eed
CDL Cert Status:
None
lEt0 2014
07/C9/2014
CDL Med Status:
None
lohnsnn
IA
Restriction
None
Supplement:
^'
.a
^�
cn
F'7
N
-71
- �
w
Citation DateACD
Conviction Date
Ex lanation Coun ]UR rn
12 x31/2011 _ _
)100/2012
15 241?014
05;'012012
992
Speed Johnson
lq
07/25/2012
06/13'2oL4
S92
Speed (10 mph & lohnson
under in 35-55 moh
-.nIe
IA
592
5 eed
]ohnsan
1q
lEt0 2014
07/C9/2014
F04
Seat Bck Vietatlon
lohnsnn
IA
Accidents - Accident involvement indicated does NOT mean the individual was at
fault or given a citation.
Sanctions
01/06/2015 102/05/2015
Name: Mohammed, Barakat Fageery DL/ID: 435AF8256
Explanation IOccurrence
of IIA
Puwsaant to Iowa Coce §321.10, I, Kim Snook., Director of Office of Driver Services, Iowa Department of Transportation, do
hereby certify that I am the custodlan 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.
Tin witness whereof, i have caused my signature and the seal of the Department to he set upon this document, at Ankeny, Iowa
this date:
8/19/21)15
IOWA Tol
` ..
yc� Office of Driver Services
Iowa Department of Transporation
Name: Mohammed, 6arakat Fageery UL/ID: 43SAF8256
O
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Aug.14. 2915 4:�5PM Div of Crmlnal [av3stigatio0 ko.3168 P, 6/1
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Des 1{gofaps, lana 50319 410 L. Washing(oo Slrae(
{515} 725.6066
(5]5)725-6090 l�ae ]UwaC ;IA 52240 c
Phune: _ 379356-5041
Fan 319-356.5497`--g—
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rl/rrel eY ble, 'P r Code f jo ut a signed n•aivar fr6n7 the subject of the request, a complete criminal history record may hof
be releasable, per Coda of iawa, Chapter co_mnlefe criminal histor
obtain a waiver si nA(ure from liac sub ect of 117o re uesf.
y record information, as allowed by law, AIWA):
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cAivision 0ICryndlalmij rwSd Bsnc6�ay—'-
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folva Cri[14ItJ8� istnr ecord Check Re tfifs
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— x, a search of the provided name and dale of birch yerealed:
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lows Criminal J"S(ury ltccord Al(aehed, DO M 'in 7.
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Received Time Aug. 13. 2015 1 46P61 Nl1.5499
A u v '4. 7fji5 4:45PM Div of Criminal Inver#Vo. ;168 P. 7i7
IOWA CRIMINAL HISTORY OCI 00954934
MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF _
DATE PRINTED-
DCLO0954934 2015/00/].9
NAME MOHAMMED, BARAKAT FAGEERY AHMED
DOB 5E% RAC HOT WGT EYE HAIR SKN POB
19710610 M 8 509 ISO SRO ELK ORK YY
ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y
CCH RECORD*+
01 ARRESTED 20120423
AGENCY_ IAC52C200 IOWA CITY PO
CHARGE NO- 01 iA STATUTE IA708,2A(2)(A)
DOMESTIC ADUSS ASSAULT
ry
TAKq: 1A00E5U01
ca
COURT DiSPOBITION�.�
s
AGENCY: IA0520I5J JOHNSON CO DISI' COURT"J-.'
N �+
COUNT NO- 01 IA STATUTE- IA708.2A(2)(A)
c)
DOMESTIC ABUSE ASSAULT
L"-ry3.
' Y rz;
-u
COURT CASE ID; 06521 SMSM089571
� #
CHARGE CLASS: MISDEMEANOR CONVICTION
—
1ACOE5UO1
<.nTRK#:
Lf:
SENTENCE DISP RFF DAT
AEFERRED JUDGEMENT $65 CIVIL PENALTY 20120710
PROBATION SY 20120730
COMMUNITY SERVICE 30H 20120730
PINE $500 20121210
REVOKED 20121210
AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT, THIS RECORD
MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF
IDENTIFICATION IS.A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW
ENFORCEMENT AGENCIES BY THE DCS.
IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDffiNTIFICATION THIS RECORD IS
BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT TME RECORD
COVERS THE SUBJECT OF YOUR INQUIRY,
DIVISION OF CRIMINAL INVESTIGATION