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Home My WebLink About16-221IDENTIFICATION NO. — r (Office Use Only) a 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 T Last 1. Name (REQUIRED) S U /:U AJ ✓ l r Iq ,< t 2. Address (REQUIRED) JA- 5-2-214 3. Contact Information (REQUIRED) Email: Csm Cell Phone:, 2-671 (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) Q — G 6 Z Z b. Taxicab Business Name (REQUIRED) "1 6'0 5. Prior experience in transportation of passengers: 1od421/p )4 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When ND 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? 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? 0 Type of offense N Where Whim - 0 hen, !7 w 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the names) NU ; 7 DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CEiAFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW 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 heVcertify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number ? 2 ./�-/( 7Z T issued orlo - 22.2ora-expiring on 0-01 - 26 2Z. 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 J4 ��-'�///`� Date a —14- STATE 1L STATE OF IOWA ) COUNTY OF JOHNSON ) Subscr' ed an sworn to before me by y�I C�TGt V� AI 1 on this day of • �Ilo Notafy Public in and Ne State of Iowa = Commission Number 221819 E ley I w� 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 Driver's license Signature of Police 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. Si� re of City Clerk or designee Approved application DCI report State certified driving record Website update ate rn r-ri , Office Use Only w , 0 C:3 cn Clerk/rAXIDRNBADGEAPPL92014amendW.DDC 07/2016 -. .. .. .. .. -. ��... ..... .��.... nv' ""Base' J/ J FfL... _-....y r, irW� v��y CINti es,�,vr a,r OOOOYM/ 09/Ogg 10;id H682 H.00R/OQd :l STATE OF IOWA t Crril"illa! History Record Check: A]� RC(iil6'.St )r'"Orli<l ' To: 'own Division of Criminal Investigation Support Operatioles Burela, lr' Floor .215 C. 7'h Street Des Moines, Iowa 50319 (515)725-6066 (515) 725.6080 has: Iowa L 1 S u 17-R A/ DC! Account Number; _� a •Z_ j t ('[applicable) Fran: —City of lona Cs. 'ty �^ City Cleric's Office "'"—•- 4101;. Wasbin ton Strce[ Iowa City, )A $2240 Phone: 319-356-5041 Fax: 31 — 9-3S63�0� 1~ b(9tell, f 0 / _ tj i �� Querxs ,seclCr•I Nambel' (reeornmenda %�� z Male ❑Female l�,i —%f'%- /33 3 I'I/rtfver Xftjor)rtUf70ft: Without a signed waiver from the subj get ofthe request, a complete criminal history record may not be releasable, per Code oflowa, Chapter 692.2. For cam,tete criminal Isistory record isstbrte cram as allowed re obtain a x elversi Itature from the cub act 2the request. law, always iI/n/VC), RDC1). n thereby grit peanise co for au above regocsling official to mneael u, Iowa erns;nal hialory regard chcei; wish iAe Division olCriminal hlvcsugauml (DCO. Any uiminal hiamq� dale concerningmc Ilial isGm�aimaincd by the�DyC1 maybe relemed as allowed bl t WaiverSfgftatnj-e;s✓ Iowa Criminal Histor Record Check Results r':: tD614lte hnry,) As of a search of the provided name and date of birth reveale4,•cn c n. r.•, . No Iowa Criminal History Record found with DO l o w J 1: ZZ G) ® Iowa Criminal History Record attached, DCI k ``I . 3.i7: W DO initials ------------ DCI-77 (0S/25/10) Received Time Sep. 22. 2016 10:02AM No. 4531 ARTS Pagel of 2 C�w►DOT vvww,iowadotgov SMARTER I SIMPLER I CUSTOMER DRIVEN Inquiry Date: Customer Name: Address: 9/30/2016 6256171 Ali, Sultan Dirar Office of Driver Services PO Box 9204 1 Des Moines, iA 50306-9204 Phone: 515-244-91241800-532-11211 Fax. 515-239-1837 www_iowadol gov Certified Abstract of Driving Record DL/ID #: 832AK7271(IA) CDL Permit Class: None Class: D Audit #: 9438610 2658 ROBERTS RD APT Issue Date: 09/22/2015 2D City/State: IOWA CITY, IA Expiration 01/01/2022 Date: Endorsements: 2 CDL Permit Issue None Date: CDL Permit 522462743 Mailing 2658 ROBERTS RD APT Address: 2D Mailing IOWA CITY, IA City/State: 522462743 Date of 1/1/1962 Birth: None Sex: M Expiration 01/01/2022 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: Office of Driver Services ID Status: None Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Supplement: CDL Permit ELG Status; Office of Driver Services D.... CDL Cert Status: None Iowa Department of Transportation CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Ali, Sultan Dirar DL/ID: 832AK7271 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 aWaccurate copy of an official record currently in the custody of said office, and that I have been authorized by the Director of the wwa Department of Transportation to so certify. ._O In witness whereof, I have caused my signature and the seal of the Department to be set upon this documegtoat Ankeny, Iowa this date: - rJ Name: Ali, Sultan Dirar DL/ID: 832AK7271 http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 9/30/2016 �Nyy4, rttllClf ®/gilt Q - IOWA'.s, 9/30/2016 `^ ::% g D. 0. T... -'Z;; -4y/ �frP.lceS.J r %f Office of Driver Services D.... "ate x Iowa Department of Transportation Name: Ali, Sultan Dirar DL/ID: 832AK7271 http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 9/30/2016