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CITY OF IOWA CITY
410 East Washington Street
Iowa Cit 2240-I8 6
<Jn9) - 56-_5040 q1 I
(319) 356-5497 FAX
1. Name
Authorization Number / tet— —J
(Office Use Only)
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olice Departeen 8 a.m
2. Mailing Address 2425 130,y4b-� RD .APS- 2--A , IOw", e n(, I A S22 ti b
3. Telephone: Home Other: (�:7 ( g-- C76 SO
4. Prior experience in transportation of passengers:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? NO
Type of offense Where When
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? ^ C _
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? .t10
Type of offense Where When
8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? /" 0
Type of offense Where When
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
'Afo
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED
DR RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEFAEVWW
You must apply for an individual Department of Criminal Investigation Report (form available upon request) The re-
port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli-
cation.
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
derMmid6vhadg 09/2010
I herebyr that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
C19&3 2 . I understand that if I falsely answer any questions in this application, that this
application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will
be denied. 1 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 a license
is granted, to comply at all time wijh�ll 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 f) S Pr
STATE OF IOWA )
COUNTY OF JOHNSON )
scribed and sworn to before me by F-F-/lroc On this I day of
L r_- _ .
I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter-
mined that there is no information which would indicate that the issuance would be detrimental to the safety, health
or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code).
Signat re of Poli6e ChieVr designee
IlLGR�?J/
A-"
Sign re of City Clerk or designee
7`'?eo-"'OK
Date
Date
After Police Chief and City Clerk have approved authorized taxi driver names will be placed on the city website at icgov.org.
Taxi cab businesses are required to provide Driver Identification cards.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
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As of, I . a soasch of tho provided name and date of bfith•revealed:
No NvA 6-1iuinol Ijistol Record found w 1th bCX
Iowa Criminal Hlstov kocoyd atiaahed, b CX
Received•Time Au8.24, 2011 4:06PM No.3413
Iowa Department of Transportation
Office of Driver Services (!Toll Free) 800-532-1721
F0 Box 9264, Des Moines, IA 5930&92G4 515-244-9124
N,W' FAX: 515-23,q-1937
Certified Abstract of Driving Record
Inquiry Date:
8/24/2011
DL/ID #:
519AG3626 (IA)
Customer #:
5827626
Name:
Mohammed, Ahmed Musa
Class:
D
ID Status:
None
Address:
1108 OAKCREST ST APT 2
Audit #:
5193626
DL Status:
VAL
Issue Date:
04/30/2011
CDL Status:
None
City/State:
IOWA CITY, IA 522465159
Expiration Date:
09/11/2016
Restriction
None
Endorsements:
3
Supplement:
Mailing Address:
1108 OAKCREST ST APT 2
Restrictions:
NONE
Date of Birth:
9/11/1966
Mailing City/State: IOWA CITY, IA 522465159
Sex:
M
History Information
CLEAR DRIVING RECORD
Name: Mohammed, Ahmed Musa DL/ID: 519AG3626
Pursuant to Iowa Code §321.10, I, Kim Snook, 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:
........W/fait
8/24/2011
IOWA
9p ORIYENgR�-'�
Office of Driver Services
Iowa Department of Transportation
Name: Mohammed, Ahmed Musa DL/ID: 519AG3626