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Home My WebLink About12-149r r"III =Ccrh CITY OF IOWA CITY 410 East Washington Street low it I wa 52240-1826 (319 356-5040 (319) 356-5497 FAX 1. Name Authorization Number /C�— / 7 -/ (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) M Last 2. Mailing Address _Z c+ 1 Z AO -a' A to w�. 1 t:} 1' j 5 ZZ -L1 U 3. Telephone: Home Other. Z I ct 5 9 cl Z3 6 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /l/, 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? NJ Tvpe of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Tvpe of offense Where When c.._+ �'Iii- C tti 45Z 1, /-, 0). 4-t., 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N Type of offense Where When 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provide the name(s) N J 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) 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) deNt.,Wvbatlg 139//2910 Qt_I ,'� I herebyy certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number, G Z7 ul Z C1 Z . 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. 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 a license 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 ++#a+++++++++++++Rww#www+ff#Mwwfa+a+f+++aa+aa+as++aaa++aw+a++x+++#*++w++w++ww+www+w+w++w++w++w+++wwa+www+fw+++w#++fw#f+aaww++w+++a++++++a++aa++a STATE OF IOWA ) COUNTY OF JOHNSON ) Su cribed and swprn to before me S�4 Z by c�ilE K. On this �5 day of 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). Signa a of P Chief or designee Date Signa of City Clerk or designee Date NOT VALID UNTIL Police ief and City Clerk have approved and authorized taxi driver names 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 u ia baegeaW2010.aa 09i2ete v C^,12oi'L. Iowa Department of Transportation Office of Driver Services Neil Free) OW -532-1721 �AtIWL 1'O Box 9284, Des fr9rbnes in 50306 -92134 515-244-9124 140 FAX: 515-239-1837 Inquiry Date: Name: Address: City/State: 7/10/2012 Elgaali, Wali Mohammed 2442 ASTER AVE IOWA CITY, IA 522406731 Mailing Address: 2442 ASTER AVE Mailing City/State: IOWA CITY, IA 522406731 Convictions Certified Abstract of Driving Record DL/ID #: 960ZZ4343 (IA) Customer #: 3342803 Class: D ID Status: None Audit #: 4940427 DL Status: VAL Issue Date: 01/11/2011 CDL Status: None Expiration 02/13/2014 CDL Cert None Date: Status: Endorsements: 3 CDL Med None Status: Restrictions: NONE Restriction None Date of Birth: 2/13/1986 Supplement: Sex: M History Information Date Conviction Date ACD Name: Elgaali, Wall Mohammed DL/ID: 960ZZ4343 JUR 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: -••:;v%'� 7/10/2012 IOWAc,.. '?°' ).0.T.:W` =41V a4apieVA Office of Driver Services BNEA ,.88110 Iowa Department of Transportation Name: Elgaali, Wail Mohammed DL/ID: 960ZZ4343 Jul. 30. 2012 1:45PM Div of Criminal Investigation No. 0455 P. 6 wt. u. evil t, ttr1d r,rty t.lerK — t,tty of 1olva illy No. ZbZ/ Y. 2 STAU OF IOWA Criminal History Record Check --Request Form . 0 . * DCiAccount Number. _` l 'd F (If eppiiwble) To: Iowa Division of CrtininaI Investigation Support Operntlons Bureau, V Floor 215 B. 7'h Street Des Xoines, Zotra 50319 (515)725-6066 (51.5)725-6080 Fax I nm requesting on Iowa Criminal History Record Check on: From: CITY orIOWACITY Cff CLF)RI<15 OIr,FZC.C,, 410.9. WASH NNGTONSTIMI;T IOWA CITY IOWA 52240 Plutim 319-356-5041 Fax: 319-356-5497 Last Name (mandatory e (mendaloq) Middle Name (recommended) E"L9a�.I1 MahCknh�,e bate Of Birth (mandato AVIelulderndatory) Social S`ecUrl Mirn1Je1'2_rj3/,Q�6 e i]Female S-(70 95 z l i 6 WaiverInformalion, Without a signed waiver from tho subject of tho regttost, a complete criminal history record may not he rolensable, per Code of Iowa, Chapter 692.2, For comalefe criminal history record illformatlont as allowed bylaw, always obtnht n waiver sienatura from the sub ieet of the renuPst. WdiVelr Meafee thereby g{vo pemdssion for 1110 above regvosting D MON to conduct an Iowa ortminal history record claok will) dte'Division oteriminai CnYoUllhilm (DQ. Any criminal hlalaty data coneemingme that is maintained by 1U ACI may ba reIrmcd es allowed by law. Waiver Signature: u — Iowa Criminal History Record Check Results (DCT4se Dory) As of V 1 7 a search of the provided name and date of birth revealed: Q V No Iowa Criminal History Record found with DCT d Iowa Criminal RistoryRecord attached, DCI# DCT initials nc%-77rnRn< lQ Received Ttma Jur 7 . 017 1.13pM Nn 09GA