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Home My WebLink About17-107 IDENTIFICATION NO. ' ` /0 p - 1 (Office Use Only) ®eta& wwa°�� 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 (319) 356-5040 (319) 356-5497 FAX First Middle Last _ 1. Name(REQUIRED) M 1A�-1(VlOO f�j�SN/ EL` I/ B 2. Address (REQUIRED) 2 5 1 5 C Learvo ate Y COv,a± 3. Contact Information (REQUIRED) Email: Q 6 dtA4k13 2 )(eche° ^ Ce ill. Cell Phone: 31 Q—t'CC-3 2 (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 03 /`�p ( `a,02 5 b.Taxicab Business Name(REQUIRED) Td' f 5. Prior experience in transportation of passengers: J p W Pt 1'`f - N1NSt.fl Cot IA 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? No o Type of offense Where When What happened to the charge?(Circle one) /0/A Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested/charged with any traffic offenses in the last five years? S el K TC-c4 - Type of offense Where When PacKNvti -\\ \c c_\ C\'� Et31� a � What happened to the charge?(Circle one) iv//- c,-< re. —co i Convicted Dismissed Deferred Suspended Plead Guo - Other prim pri ]s I el 8. Has your driver's license or chauffeur's license been suspended or revoked in the last fivt s?3g Type of offense Where t When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) N0 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 that I have issued to me by the Iowa Department of Transportation a valid Driver's license number 4%4 b R H7�g�p issued on 2/3/2o/7 expiring on 3/aa/a o7,5 . I understand that if I falsely answer anyquestions 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 !tyP�J Date g /2 - / 7 **************:**************************************************************************************************AAAA************************** STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by ka0_ j _ gk on this U day of • s �d►a WENDY S.MAYER a28 No ary Public in d fa-4e State owa ;79; T- Iny coin • ion Aires ********* -fir - ************************** *** ************AAAA*AAAA*******A*A A*Ak**************AAAAAA#AAAA* 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 •ate o I ri -r's f ense j12 b/ Z V/t//) Sign: re o 'olic�4f designee e 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. Signature of City Cif or designee Zfle G.) dowdy ************************************ ***********A****************Or****A* .**** AAAA*****AAAA** rn Office Use Only --- Approved application DCI report State certified driving record Website update Clerk/TAXIDRIVBADGEAPPL9201 4amended.DOC 07/2016 0. IOWA DOT SMARTER I SIMPLER I CUSTOMER DRIVEN WVVVV.ioWad0 .goV Office of Driver Services PO Box 9204 I Des Moines,IA 50306-9204 Phone:515-244-9124 1800-532-1121 I Fax:515-239-1837 www.iowadot_gov Certified Abstract of Driving Record Inquiry 8/15/2017 DL/ID #: 620AH7686 (IA) CDL Permit Class: None Date: Customer 6005005 Class: C CDL Permit Issue None #: Date: Name: Eltyeb, Mahmood Bashir Audit#: 1590115 CDL Permit None Expiration Date: Address: 2545 CLEARWATER CT Issue Date: 02/03/2017 CDL Permit None Endorsements: Expiration 03/20/2025 CDL Permit None Date: Restrictions: City/State: IOWA CITY, IA Endorsements: NONE ID Status: None 522464139 Mailing 2545 CLEARWATER CT Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA Supplement: CDL Permit ELG City/State: 522464139 Status: Date of 3/20/1973 CDL Cert Status: None Birth: Sex: M CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Eltyeb, Mahmood Bashir DL/ID: 620AH7686 (IA) 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: 1142 -n OPE A`�ni c's `4k.,,....,,./b�� / 8/15/2017 "^' COro s v' IOWA yi`', -Vea..66.«/Opiegag =B. rn I4 1ii t la% Iowa Department of Driver rtme tServices ansportation N Name: Eltyeb, Mahmood Bashir DL/ID: 620AH7686 (IA) Aug. 17, 2017 9: 19AM Div of Criminal Investigation No. 8393 P. 2/3 'f=ro rv: Ity of Iowa City CI erK Off Ica 319 3565x8'/ 08/14/2017 1S: se 0-17e. r.trv2/002 rm. /1,, vor • , . i:1 P"'''VA JO • . T°7' u4t STATE OF IOWA 4'..5^� Def iJF, /4 iib t • ,1 .Yi i r. WAtr.; CIirliL/lii1l� History Cheek U : ,�- y � , ti 1;; Request rai�� ° ; 40111.° DC1 Account Number: _ t:.0-�L:L -- (if applicable.) To: Iowa J)ivisian of Criminal Investigation From: City of Iowa Cid Support Operations Bureau, 1s1 Floor City Clerk's Office _______ _ 215 E.714 Street 41E,.Washflt, ou Street Des Moines,lows 50319 .c! . (5151335tsfl6 lova Gig, Lk ;a2140 — (515)725-6080 Fax • Phone: 319-356-5041 Fax: 3319-356-5497 I am requesting an Iowa Criminal Histol Record Check on: Last Name (mandatory) First Name(mandatory)_ I Middle Name(recommended) - Dare of Birth(mandatory) Gender(mandatory) • Social Security Number (recommended) O , P,0 ^ 1C\ 3 JE,Male OFemale 3 CA 46 f 1 — C J 7 a Waiver Lzformation:Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 692.2,For complete criminal history record information,as allowed by law,always . obtain a waiver signature from the subject of the request. .._144aiver Release:i hereby givrpennissroTrio-nt aboyc(Ousting omeial to conduct an Iowa criminal history record check with rlicDivision of Criminal Investigation(DCI), fi,y crimi,tal hittory dais concerning me that is maintained by the DCI may be released as allowed by law. • Waiver Signature: A.-4, ---- 1 . - ,--1... eA: . LC) . 1,1.,( -14,,c,.l' It]'W'a Critnil � axv ecoz-d check results CO —'O tSc only) As of )1— ) , a search of the provided name and date of birth revealed: C No Iowa Criminal History Record found with DCI =`tg3"I' A, 0 Iowa Criminal History Record attached,DCI# EV SP • DCI initials • DCI-77 (08/25/10) Received Time Aug. 14. 2017 3:33PM No. 4831