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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
IDENTIFICATION NO. .11 ,0 r-;iaV
(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)
Failure to complete the "required" information will result in denial of the application
le
1. Name (REQUIRED) _
2. Address (REQUIRED)
3. Contact Information (REQUIRED) Email:
G c^ r' 1 AIL Cell Phone:
sent via email)
e
4a. Chauffeur's License expiration date (REQUIRED)
b. Taxicab Business Name (REQUIRED) - O �n it ( r o b
5. Prior experience in transportation of passengers:
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere?
Type of offense Where When
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty Other
7. Have you been arrested / charged with any traffic offenses in the last five years? /I/
Type of offense Where When
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty Other
B. 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 prauide the-mame(s - '
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED `"
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF RENEW; •';
t:o
You must apply for an individual Department of Criminal Investigation Report (form available upon request).
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)
02/2015
T
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
I hereby` ce ify jha I have issued to me by the Iowa Depyyyyyartmen/`/`t of Transportation a al' Chauffeur's license number
t+f issued onexpiring on `t f I understand that if I
falsely'answer any questions in this application, that this application may be denied. I gree 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_ Date
<xxx.xxxxxxx.xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx�xx.xxxxxxxxx,xxx,:xxxxxx,t,...xxx..xx,xx�xx.xxx.xx.:.xxxxx,..x�«xxxxxx...,xx.xx tx,�xx.xx.x,xx.xxx
STATE OF IOWA )
COUNTY OF JOHNSON )
S^bs1cribed and sworn to before me by _2<kci), tl7 A , � � / n� Q A on this `5 day of
"k -Ax -u n r-, -1_ y Lo
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 q,/6/
zc�')
Signature of Police designee .pate-
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.
Sign�1Sa of City Clerk or designee
Date
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxx:ux+xxxxxxx.xxxxxxxxwxxrxxxxxxxxxxxxxxasxxxmx:uxxxxxxaxxxxxxxxxxxxxxxxxxxxxxxxxxr,axxii;�w_t'xxxxx*zxxexxxxxgxxxxxsxa
C”
ffice Use Only
Approved application
DCI report
State certified driving record
Website update
CTed/AXIDRIVBADGEAPPL92014amended,DOC
03/2015
Frfeb. 1. 2(16, 9�02ANi,la,Div of Criminal Investi,ation No•6551 P. 2/2
-
S'T'A'G'E OF IOWA`app
Crlafl1113! History Record Check
Request Foran s
To: Iowa Division or Criminal Investigatlon
Support Operallans Burcau, I" Flonr
215 E. 7" Strect
Des Moines, Iowa 50319
(515) 725.6066
(515) 725.6080 Fax
Criminal
M4.hcfr
4'11' r ll
Del Account Number;
(ilapplicable)
From; City of Iowa City
Clly Clerk's Office
410 E. Washhr top Street
fovea City, IA 52240
Phone: 319-356.5041
Fax; 319356-5497
I `&Le OFemale
11L f /¢ /d Yl l e c.
l•
2`i- 12--5zF1
waiver 1nJ0rmarr0n: \WI(houl a signed waiver from the subject of the request, a complete criminal history record may not
be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record information, as allowed by law, always
Obtain a Wa1VBr el ono tnrn fLnm Ihn ou Alw..l. raL-
Waiver Release: 1 hereby give peMliscion for the Above requesting official (o con& am loses criminal history record check wish I he Division of Cdosinal
h1vetligalion(➢(7I), Any rriminal history dose concaningme diet is male,ined y s(he DC1 may be released as allowed by law.
Waiver Signature; �+,�,.
Received Time Jan.29 2016 12;01PM No -6322
As of
–� (r, a search of the date
w` provided name and of birth revealeda';
No Iowa Criminal History Record found DO
cmc
with
iJ,
®
lorva Criminal Hisiury Record attached, DC1 fl
N)
—r-'.
e a —
DC1 initials—hiL_
DCI -77
(08/2511(1)
Received Time Jan.29 2016 12;01PM No -6322
C r 00T
S�!,':Ri 611.IMts Iti.?7TOMERDRIVEN trv�JVu .1 Ic��tf GO . C'r
Inquiry
Date:
Customer
Name:
1/29/2016
6036513
Pagel of 2
Office of Driver Services
PO Be, `Q(204 (Des Moues.. CA 5036,33-9204
Pho..e' Et15-244-q!24 ;A6 ;32-1121 I Fa,t 59 fre"24-1Ec37
www.iawadi gav
Certified Abstract of Driving Record
DL/ID #: 666AJ3549 (IA) CDL Permit Class: None
Class: D
Mandi, Khalid Ali Ahmed Audit #: 7903214
Address: 2650 WHISPERING
PRAIRIE AVE
City/State: IOWA CITY, IA
522406812
Mailing 2650 WHISPERING
Address: PRAIRIE AVE
Mailing IOWA CITY, IA
City/State: 522406812
Date of 9/8/1971
Birth:
Sex: M
Issue Date: 03/20/2014
Expiration 09/08/2018
Date:
Endorsements: 2
CDL Permit Issue None
Date:
CDL Permit
None
Expiration Date:
Restriction None
CDL Permit
None
Endorsements:
CDL Permit
CDL Permit
None
Restrictions:
ID Status:
None
Restrictions: NONE
DL Status:
VAL
Restriction None
CDL Status:
None
Supplement:
CDL Permit
ELG
b.........a'/��
Status:
IOWA ? 5
CDL Cert Status:
None
D. 0. T. '
CDL Med Status:
None
History Information
CLEAR DRIVING RECORD
Name: Mandi, Khalid All Ahmed DL/ID: 666AJ3549
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:
Name: Mandi, Khalid Ali Ahmed DL/ID: 666A]3549
1/29/2016
b.........a'/��
1/29/2016
IOWA ? 5
D. 0. T. '
r
7F "••"' 4 =
Office of Driver Services
Iowa Department of Transportation
_
Name: Mandi, Khalid Ali Ahmed DL/ID: 666A]3549
1/29/2016