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Home My WebLink About16-102IDENTIFICATION NO. jte —J C� Z (Office Use Only) °'a - t._ APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday- Friday) 410 East Washington Street Iowa city. Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application (3 19) 356-5040 (319) 356-5497 FAX First / Middle , Las 1. Name (REQUIRED) _y'o 17Lh (J 16 �2. Address (REQUIRED) 256 RD cVfG ZZ -CL 3. Contact Information (REQUIRED) Email: iL IPY7i1-111I"Iz h+✓IGtd'>(®wlCell Phone: Uoq .-Lfb1+_ Al (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) j Z- 0 1 / /Z,� Z I b. Taxicab Business Name (REQUIRED)_ � �'�_ (_'4 5. Prior experience in transportation of passengersC20 Z \i n A it 6. Have you ever been arrested I charged with any misdemeanors and/or felonies in this State or elsewhere? r -f o Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where When What happened to the charge? (Circle one) 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? 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 n"ame(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 upor;-1 uest). C--.) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify �thqat I have issued to me by the Iowa Departm nt of Transportation a valid Chauffeur's license number q -IG 4 A`� ?_5 72 issued on ��expiring on o 1 � 1 understand that if I falsely answer any questions in this application, that this application may be denied. I a ree 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 V6IIAWf Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me bytv'� CAU L'LP�i A . tj�_ ArDCtlrJimon this I FD day of r' MMftN a~ 721M Notary Public in and the State of Iowa !ft EmM -r r 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 b etrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration da f Chauffe 's li n e - 1210112021 \� l� 20 gnature`of Police Chief or desi 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. ?ignabret a� 4,� of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update S 11e117 pie 'Date cie,krrarioRIVE oGEAFaL92014amend� Doc 03/2015 Frrviay. iu, [uin 4:uyrwi uiv 0 � r i m i n a i Inv estigatjoo iVo J 9 4 4 F. 1/1 -,- ------os/Oe/2018 ll:.I lag; -„,,.,,2/002 STATl+ OF 10147 Criminal HiPtory Beetled Che(:! @ Regticst FO1'E11 1arov8 WASIon er Criminal lnve.gipilon :3aNurt oper 6wis 13urcau, i” Floor 215 E. 71" Street Des Moines, luwa 50319 (515) 725-6066 011S) 72S-6090 rax DCA J I/ronr Cio(fawa Cies City C lerlt',p 01fice——_-._...--'-- 41G);, 1X�usUinglon 6lrccl folva Ci( , LA 52240 , Phone; 319-356-5041 _ l Fax: 319"3565497 —� 0 5`� a search of the provided pante and date of birth vcveaicd: i No Iowa Criminal History Record found with 1701 C'1 lowa Criminal HisloryRecord atlachcd, DCI initials_ 00-77 (08/2S/10) Received Time May, 6. 2016 11:2)AM No,4521 @C7 �n� unl�9 v 1 6. -•r�.- 1.� C4iUVVAD0T www1owaidlotgov SNA ARTfR t 51141PLvt. I CU3TOMEb DRIVIN Inquiry 5/18/2016 Date: 2656 ROBERTS RD APT Customer 6464036 Mailing IOWA CITY, IA Name: Abdalla, Mohamed Date of Ahmed Mohamed Address: 2656 ROBERTS RD APT Sex: 2B City/State: IOWA CITY, 1A Office of Driver Services. PO Pox 92flA i Des (Moines, FA 5gW45-9204 Phone: 515-244-�4124I 80 ,532-1121 i Fax 5bF�235-1£37 www .lowadotgov Certified Abstract of Driving Record DL/ID #: 980AM2922 (IA) CDL Permit Class: None Class: D Audit #: 9802922 Issue Date: 02/23/2016 Expiration 12/01/2021 Date: Endorsements: 2 CDL Permit Issue None Date: CDL Permit 522462742 Mailing 2656 ROBERTS RD APT Address: 2B Mailing IOWA CITY, IA City/State: 522462742 Date of 12/1/1971 Birth: None Sex: M Office of Driver Services. PO Pox 92flA i Des (Moines, FA 5gW45-9204 Phone: 515-244-�4124I 80 ,532-1121 i Fax 5bF�235-1£37 www .lowadotgov Certified Abstract of Driving Record DL/ID #: 980AM2922 (IA) CDL Permit Class: None Class: D Audit #: 9802922 Issue Date: 02/23/2016 Expiration 12/01/2021 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 Status: CDL Cert Status: None Office of Driver Services - CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Abdalla, Mohamed Ahmed Mohamed DL/ID: 980AM2922 Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that 1 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: Abdalla, Mohamed Ahmed Mohamed DL/ID: 980AM2922 Ta D7�pi 10 WA D. 0. T. f 9%''••••''� Office of Driver Services - aw�,�= Iowa Department of Transportation Name: Abdalla, Mohamed Ahmed Mohamed DL/ID: 980AM2922