The URL can be used to link to this page

Home My WebLink About17-116 IDENTIFICATION NO. / r 1 I (s)e. (Office Use Only) 42117;aft 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 Washintton Strrrl Iowa City. Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application 1319) 356-5040 (319) 356-5497 FAX First Middle II Last 1. Name (REQUIRED) First, !! ii t✓i-Giern US-i'c'+ 2. Address (REQUIRED) A&O ( ctJ t� I )) G CI LA R s2"Z Lt(� 3. Contact Information(REQUIRED) Email:14c.t►mo,v E.)rL 4-Tn.--t; •• c '-`4 Cell Phone:3 J y-.3 .7-5 / (t. (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 0(1 /i I ( g b. Taxicab Business Name (REQUIRED) co 6 5. Prior experience in transportation of passengers: Nob, \ (0) '- \i L Jl ek;v C '--y C,‘Ac 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? IV 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? Se'e-ed Type of offense Where When 5f To1 ,.. Co. a 543 / I 4 What happened to the charge?(Circle one) Convicted Dismissed Deferred Suspended< PleadGui tai ) Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? E N Type of offense Where 7:0).3911 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please plobtde tlie-names N 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 certifythat I.have issued to me by the Iowa pepartment of Transportation a valid Driver's license number 3 /1..5 iS 1f issued on /f-/2c13expiring on 0//i'g 0_01'g . 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 Date Jo o 7' — 201 ************* **.*.**********.*** ************ ##******##x #+# STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by K q uyt c)‘ G . VA LiS}-cLc-c..._ on this "7 day of Y Notary u lic in a for the a of lo or' is wcµn s.MAYER z t Commission Number 729428 M �r sslon(�pins nw -4`!• • *** 0****** ******###.******************###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 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 Ol}- (8 •2_A! B ‘........././) 4._ sot • o7. zei6 Signature of Poli 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. c •- , . ,,,,,,:,._,,\',,,=-!v--,,... \D\ q\kkk Signature of City Clerk or designee Date �;)� „it N O Cr. Office Use Only D- '24 ri C-,-< I r.�n r Approved application •ern DCI report ,-):74 State certified driving record -_ N Website update - ClerMAAXIDRIVBADGEAPPL92014amentle'.DOC 07/2016 r-r UC I, 0, 1U10„ 9:3Irmoiorsuly of vriminal_invesiigdssull .,o,osiams ss:6Y'tU1/roo''. 5:.`_,002 as i STATE 01? IOWA • lawa- Criminal History Record Check mait3 Request Fenn 41 elDCI AccolnstNtuiber: c c0. (if opplirahie.) To: Iowa Division Of Criminal Investigation From; City of Iowa City _ Support Operations Bureau,1"Floor City Clerk's Office 2151_,71h Street 410 L.Wasbing1on Street Da Mohler,Iarge 50319 (515)925.6066 Iowa City, IA 52240 (515)725-6000 Fax --- Phenol 319356-5041 Fars 3/9-366-5497 I am requesting on Iowa Criminal History Record Check on: Last Name(mmsdatosy) First Name(mandatory) Middle Nemo(rceammenaea) MU'S -R q ulna It ELoi ie vk Date of Birth(mnsdmonj Gender(nnndatory) Social Security Number(seeammcnded) 7- 11 - 19 :7-5- ®(Male ❑Female 52 J9 GC-1-i 67 Waiver Information:Without a signed waiver from the subject of the request,a complete eriminel history record may not be releasable,per Code of Iowa,Chapter 692.2.For complete criminal history record information,na allowed by law,always obtain a waiver signaturefrom the subject of Use request. Waiver Release:1 hereby give pmnis:Inn to:the aboverequesting aA)dnl to conduct en Iowa criminal lsistoryrccota cheek xitit theDivtsion atC iodsul Invesitgeifon(DCO, Any criminal Moon'dela eanumtn rat Mt IsmainWned by the DCI may be reneged ai aloud by law. WaiverSignature: Iowa Criminal History Record Check Results met ate only) As of \C7,�o \(�e , a search of the provided name and date of birth revealed: 1 No Iowa Criminal History Record found with DCI ❑ Iowa Criminal History Record attached,DCI# DCIinitials AC_ w ! • r,) " DCI-77(08/25/10) Received Time Oct. 3. 2016 3:36PM No. 5281 fi /04:airt ‘ ifirp.: stApoT SMARTER I SIMPLER I CUSTOMER DRIVEN WWW'IOWadOt SOV Office of Driver Services PO Box 92041 Des Moines,IA 50306-9204 Phone:515-244-91241800-532-11211 Fax:515-239-1837 wwet.iowadoi.gov Certified Abstract of Driving Record Inquiry 10/4/2016 DL/ID#: 733AJ9154 (IA) CDL Permit Class: None Date: Customer 6142527 Class: D CDL Permit Issue None #: Date: Name: Mustafa,Kamall Eldlen Audit#: 7349572 CDL Permit None Expiration Date: Address: 2602 BARTELT RD APT Issue Date: 09/17/2013 CDL Permit None IC Endorsements: Expiration 09/18/2018 CDL Permit None Date: Restrictions: City/State: IOWA CITY,IA Endorsements:3 ID Status: None 522462727 Mailing 2602 BARTELT RD APT Restrictions: NONE DL Status: VAL Address: 1C Restriction None CDL Status: None Mailing IOWA CITY,IA Supplement: CDL Permit ELG City/State: 522462727 Status: Date of 9/18/1975 CDL Cart Status: None Birth: Sex: M CDL Med Status: None History Information Convictions Citation Date Conviction bate ACD Explanation County JUR 05/23/2014 09/04/2014 592 Speed Johnson ,IA 10/05/2014 10/16/2014 .S92 Speed ;Johnson IA Name: Mustafa,Kemal]Eldlen DL/ID:733A39154 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: ao�Fitrpal rj•IOWA . 10/4/2016 D.O.T.44) ,Q�,taa.JOplP I' DBIYEB Office of Driver Services