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Home My WebLink About16-195�III� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO )Q5 -- (Office ust: �111yi APPLICATION FOR TAXICAB / 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 3. Contact Information (REQUIRED) Email:Qrhar2l�NnS1n; rg.gwO�L-COIA Cell Phone: -31r1-3i3- 5-72 C? (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 03 / 9=6 /� m a. b. Taxicab Business Name (REQUIRED) -,A wdr i uW1 Ca 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?Its 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? Ny 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? Type of offense Where When V0 v 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please prs- ide th 6\Aame(s,)- DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED i-.,) DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE C141EF REyIEW You must apply for an individual Department of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number ri4 q A i7 � r.9- issued on WI IA expiring on 3/2(, / 2 . 1 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 AVv� Date�G STATE OF IOWA ) COUNTY OF JOHNSON ) Su scribed and sworn to before me by AyAq.� �. �bnf45L� on this Z�� day of 1 La CA WY S• 7211 Notary Public and for the State of wa ws 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). license / % 61Z I or &2z Zti ate 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. 22i,,,d� -k . � Signa re of City Clerk or designee Date #+ml+mlf#f##ff#+#f###*+**!*!!!!!!!f#fmffl++f#*#*##+##+*#m**lm+++x#++m#+++++m++#++#+m+e+++*+m+++m++++++++#++++++m+mm+++ N CJ Office Use Only 3 _ -r-a Approved application = c a DCI report —,,j State certified driving record Website update CID ClerkfrAXIDRIVBADGEAPPL92014amended.DOC 07/2016 Aug. ll. 2D 16 2:47PM Div of Criminal Investigation No. 0836 P. 4/6 Fr..;•..... .. ... .., .._ .-..,Y C1.1— _. �....o ".e -----e. oa/76 /2D18 lasso 062b 1.uu2/002 STATE OF 10YYA 'i �hlOV1A)a e CrimiVIM Histou Record h i k FFF, QQ\\,J 2 IF 1 T Request YV .a,:inCpa IeY'��1� TO! Iowa Dfvfsfon of Criminal Itivee(igfltton Support Operations Bureau, 1`t Floor 215 E. 7'a Strect Deg Moines, Iowa 50319 (515)725.6066 (515)725.6000 Fax I am reonesllnp an tnsun rriae, —, n__,...a DCl Account Number; 40 Oa, _ r, (ifapplieahle) �— Froin; City of Iowa City City Ulm -We Office -- 410 11. Washinf ton Sheet Iowa CLY, IA 52240 Fhoue: 319-356.5041 Fax: 319-356-5497 Last Name (nlandn olr) C o�a5�1 Mrst Name mnndalop9 Middle Nau1e (recanamended) /ice EIvrla5rcaFf� Date Of 131rt11 Onnedelory) Gender mandatory) S/ocial Securit Number Cretenintended) ,, tt 03/026/ /�7 ®Aline Melnale (�%�–�({-3C) Waiver rflf0rHlt71i07l: Willioutit signed waiver from the subject of the request, a complete erlmlual history record mfly not be releasable, per Code (if Iowa, Chapter 692.2. For comnlgte crimhaal history record informatfolr, as by allowed law, alwals obtoln a waiver signature Brom the subject of the request Mai 'er Refease: l hemhy give peraslssion for she ubove requothig ofneial to conduct an low' C iminal hislory «cord Check with he Division otCrilubjej tnvesligation (DCI). Asst' criminal hislory data conceming nit that is maintained by 1111 DC1 may be released as alfomd by law. Waiver SigneWire: .Iowa Criminal ..History Record Cheek ,Results (DCI nse only) As of—/ a search of the provided name and date of birth revealed: No IDwa Criminal History Record found with DCI I rl Iowa Criminal History Record attached, DCT DCl initials__ DCI -77 (08/25/10) - Received Time Aug. 15, 2016 2:21PM No,1703 C4410WADOT vwvw,iowado gov SMARTER 1 SIMPLER I CUSTOMER DRIVEN Inquiry 8/25/2016 Date: 2504 BARTELT RD APT Customer 5876365 Mailing IOWA CITY, IA Name: Elgorashl, Amar Date of Elmustafa Address: 2504 BARTELT RD APT Sex: IA City/State: IOWA CITY, IA Office of Driver Services PO Box 9204 i Des Moines, IA 50306A204 Phone: 515-244-9124 1800-532-11211 Fax: 515-239-1837 www.iowadot.gov Certified Abstract of Driving Record DL/ID #: 549AG7752 (IA) CDL Permit Class: None Class: 522462714 Mailing 2504 BARTELT RD APT Address: IA Mailing IOWA CITY, IA City/State: 522462714 Date of 3/26/1984 Birth: None Sex: M Office of Driver Services PO Box 9204 i Des Moines, IA 50306A204 Phone: 515-244-9124 1800-532-11211 Fax: 515-239-1837 www.iowadot.gov Certified Abstract of Driving Record DL/ID #: 549AG7752 (IA) CDL Permit Class: None Class: D Audit #: 9946280 Issue Date: 04/19/2016 Expiration 03/26/2021 Date: None Endorsements:3 ' Restrictions: Corrective Lenses Restriction None Supplement: History Information CLEAR DRIVING RECORD Name: Elgorashl, Amar Elmustafa DL/ID: 549AG7752 CDL Permit Issue None Date: CDL Permit None Expiration Date: None CDL Permit None Endorsements: CDL Permit None Restrictions: ID Status: None DL Status: VAL CDL Status: None CDL Permit ELG Status: CDL Cert Status: None CDL Med Status: None Pursuant to Iowa Code §321.10, I, Melissa Spiegel, 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: ;�/�:'AI, 8/25/2016 n IOWA 's� � j3j 4 // ff is -�lli/i7.y—i( ). 0. T.,ri i' 0e� "' Office of Driver Services ate. Iowa Department of Transportation Name: Elgorashl, Amar Elmustafa DL/ID: 549AG7752