The URL can be used to link to this page

Home My WebLink About16-249+. Mlr®i�Il CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 5 22 40-1 82 6 (3 19) 356-5040 (319) 3S6-5497 FAX IDENTIFICATION NO. I� .. :�L� `� (Office Use Only) APPLICATION FOR TAXICAB I 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 First 1. Name(REQUIRED) M6dNSr� Middle Lpst 2. Address (REQUIRED) 2S6\ Q �&e,,-� die jay \ "-L C5-, I A ' 3. Contact Information (REQUIRED) Email: cjMea - Cu~1 Cell (All written communication sent via email) 4a. Driver's License expiration date (REQI. b. Taxicab Business Name (REQUIRED) 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 aj+ When t6\3 What happened to the charge? (Circle one) ' cT:)` --j Convicted Dismissedeferr Suspended Plead Guilty "Ofi%r '— ca-„ Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where i/yFien 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 r-? 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) ,r,J 6 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 upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify I h that ave issued to me by the Iowa Depa ment of Transportation valid Driver's license number 62?-(�(� 6Uc� issued on o 4 expiring on 4I )f / 9•'lL . I understand that if I falsely answer any questions in this application, that this app ica ion May be denied. II agreTee 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 t 3 S' hJ L� s+ssfsffffxffxxsssssifxffifxwfs xfxxwfxxfffxffxfxxxxwxxwfxxxwwfxxwffxxsfxffwfffxxfffwfxxffxxxfxsfxxwxxxxffxxf.t+sr;Rfffffx'xwfls+w�fffiffffn STATE OF IOWA )x a COUNTY OF JOHNSON Subscribed and sworn to before me by LAAAQAA nedM< on this -� ` "d day of 0 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 / 4�/22_ OW_� Signature of Police Chief or designee ,V A-7 �l 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. ignat re -of City Clerk 6r designee // 7 /� ate xxxxxxxxxxwfwwxxxwwxxxfxxwxxxxxxwx++w+xxwxxwwxxwxxwxxxxxwxxxxwxxxwwxxwwwxxwxxxxxxxxxxwxxwxxxxfxxxxxxx++,xwwxxwwfxfffffwfxxx,wwfxwff,xfff,f„f„f Office Use Only Approved application DCI report State certified driving record Website update CIeN✓ IDRIVBADGEAPPLWOUamendWtlDOC 07/2016 %010/0Ct_28, 2016011_26AM,apDiv of Criminal Investigation sic_ . STATIE OF IOWA •s in5rvn ;- Lf/�oli�lil� ,Y story Record Request Form lft S:Tz�1*, To; 101YA Dlvlslun ofCrlminul lnyostlgollon Support Operations Bureau, 1" Floor 215 F. 7" Street Des Molnar, lows 50319 (515) 725.6066 (515)725.6080 Fax - No. 6369 P. 1/2 (FAX)3193382..,,, , /002 DCI Acoount Number; _9967-F (Ir Opp lleeble) From; 'Yellow Cab of Xowa City P.O. Box 428 Iowa City, IA. 52244 (319) 338-9777 Phone) Fax: (319) 339-7302 (DCI Yeo only) As of 1CA (J0 , a search of the provided name and date of birth revealed: I ❑ No Iowa Criminal History Record found with DCI I. r— Iowa Criminal History Record attached, DCI 4 `1 C U DCT Initials DCI -77 (08/25/10) , Received Time Oct -24. 2016 9:11AM No -6682 Oct.28. 2016 11:26AM Div of Criminal Investigation ADDITIONAL IDENTIFIERS PROTO AVAILABLE; Y CCH RECORD *** 01 ARRBDTED 20130917 AGENCY: IA0520100 CORALVILLR PD CHARGE NO- 02 IA STATUTE IA708.2(6) ASSAULT TRK#: 1A00HL702 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA708.2(6) ASSAULT COURT CASE ID: 06521 AGCRIO3031 CHARGE CLASS: NON CONVICTION TRK#: IA00HL702 SENTENCE DISP EPF DAT FINE $100 20140310 DEFERRED JUDGEMENT $100 CIVIL PENALTY 20141118 PROBATION lY 20141118 DISCHARGED FROM 20141119 DEFERRED JUDGEMENT 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 DCT, IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INOUIRY. DIVIISSION OF CRIMINAL INVESTIGATION 1r No -6369 P. 2/2 IOWA CRIMINAL HISTORY DCI 00989990 NON CONVICTION PAGE 1 OF I DATE PRINTED - 2016/10/28 DCI:00989990 NAME: MOHAMBDALI,MODASIR KHIL DOE SEX RAC HGT WGT EYE NAIR SKN POB 19630928 M B 506 199 ORO BLK DRK YY ADDITIONAL IDENTIFIERS PROTO AVAILABLE; Y CCH RECORD *** 01 ARRBDTED 20130917 AGENCY: IA0520100 CORALVILLR PD CHARGE NO- 02 IA STATUTE IA708.2(6) ASSAULT TRK#: 1A00HL702 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA708.2(6) ASSAULT COURT CASE ID: 06521 AGCRIO3031 CHARGE CLASS: NON CONVICTION TRK#: IA00HL702 SENTENCE DISP EPF DAT FINE $100 20140310 DEFERRED JUDGEMENT $100 CIVIL PENALTY 20141118 PROBATION lY 20141118 DISCHARGED FROM 20141119 DEFERRED JUDGEMENT 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 DCT, IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INOUIRY. DIVIISSION OF CRIMINAL INVESTIGATION 1r No -6369 P. 2/2 ARTS Page 1 of 2 C1J10A`WAD0 wwwJowadotgov SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Driver Services PO Box 9204 i Des Moines. 1A.50306-9204 Phone: 515-244-9124 1800-532-1121 f Fax: 515-239-1837 www.iowadot.gov History Information CLEAR DRIVING RECORD Name: Mohamedali, Modasir Khlilil DL/ID: 082AA0058 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: u-* ....... r/�,'l1 IOWA *%ca�.J 11/3/2016 Certified Abstract of Driving Record Inquiry 11/3/2016 DL/ID #: 082AA0058 (IA) CDL Permit Class: None Date: Customer 1142265 Class: D CDL Permit Issue None #: Date: Name: Mohamedali, Modasir Audit #: 8489835 CDL Permit None Khlilil Expiration Date: Address: 638 WESTGATE ST APT Issue Date: 09/30/2014 CDL Permit None 46 Endorsements: Expiration 09/28/2022 CDL Permit None Date: Restrictions: City/State: IOWA CITY, IA Endorsements: 3 ID Status: None 522464636 Mailing 638 WESTGATE ST APT Restrictions: NONE DL Status: VAL Address: 46 Restriction None CDLStatus: None Mailing IOWA CITY, IA Supplement: CDL Permit ELG City/State: 522464636 Status: Date of 9/28/1963 CDL Cert Status: None Birth: Sex: M CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Mohamedali, Modasir Khlilil DL/ID: 082AA0058 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: u-* ....... r/�,'l1 IOWA *%ca�.J 11/3/2016 7f�BIYE� Dal Office of Driver Services Iowa Department of Transportation Name: Mohamedali, Modasir Khlilil DL/ID: 082AA0058 http://172.29.254.55/drivers/reports/customerhistorylcertifieddrivingrecord.aspx 11/3/2016