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Home My WebLink About12-1507. Have you been convicted of any traffic offenses in the last five years? 0 Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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) N1 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) cleikta idrivbadg talo obiaolZ Authorization Number «— / 50 l 1 (Office Use Only) III CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 410 East Washington street between 8 a.m. to 3 p.m., Monday — Friday.) low Cil Iowa 52240-IS26 319) 356io4o (319) FAX First ' ! Middle Last qq 1. Name �G 0 VIGIiYI� 99i//�gIV��'C� LL 2. Mailing Address 1,r' 3. Telephone: Home -719 .3 Other: 4. Prior experience in transportation of passengers:Ini P _ 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 6. Have you �een convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years?p0 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? 0 Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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) N1 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) cleikta idrivbadg talo obiaolZ I here y ce ify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number 257 JA rS, 4 ?--z>,'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. 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) �I,O 2 Signature of Applicant � Date 3 STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by a m -e ci o a n ; < On this 3 `( day of `30/-;- SONDRAEFORT °� Commission Number 159791 Sun dnt,.irJvi/ 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). Date Date NOT VALID UNTIL Police Chif 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 deik/faxldmbadgsap92010xbc 09401.Q 7ul.31. 2012 4:15PM Div of Criminal Investigation du I.iu. [ul[ I,I[rm bity blerlt - bity OT Iowa wly STATE OV I®'PVA Criminal Hi9tory Record Check Request Form To: Iowa Dlvisiou of Criminal InVesilgation Support Operations Bureau,1" Floor 215 X 7'b Street DesMOines,IOWa 50319 (515) 725.6066 (515)725.6000 Fax Record MrstI rhe tvoo-[b462 PP. [1/15 DCIAccountNumber: 'Yooa r (lrappltaoble) From: CITY Ox' IOWA, CITY CITY Ci ARK'S OFFICL 410 E. WA8MNGTOp7 STRLBET IOWA CITY IOWA 52240 Phone: 3193566041 Fax; 319-3565497 Rate 0011-thh hiondalory) Geud�o (mandato Soc4al S;ecuri Number (racommcaded 6 �" b ' ldlYiale �k emalo /• Wrtdvef lnfat jnatdonl Without a signed walver e•om the slrbjocr of tho request, a complete criminal history record may not be releaspble, pet Code of Iox'a, Chapter 6922, Vor com let criminal historyrecord Info motion, as allowed by IoW, a1Wpy9 I ailYEYRekayeaIherebyglvoptn1*11oaforVicohovarequostloZoMoleltoconduotanIowacrhnhalh6toryMbr4die*wiAhthoNVishbaNdminal rnvrsligarfon (DCO- Myulmbial 1114101y dots mnum4rg mo that Ismdntalncd bytho Ata my ba mlomcd as el(owod MAW. WaiveYSig>:ar�tuY¢- 1-1�-. (DCtuso only) As of 101111, , a search of the provided name and date of bHx revealed: }) o�—No Iowa Criminal 14istory Record found with ACI Iowa Criminal History Record attached, DCI DClinitAgl rb D__.!.._J r:_-1•I.,I On nonto I.{DDt6 M. AAAI — — — —. Iowa Department of Transportation Office of Driver Services (roil Free) OW332-1121 V PO Box 9204, Des Moines, IA 503DB--9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 7/28/2012 DL/ID #: 56SAG4232(IA) Customer #: 5903018 Name: Hamed Mohamd, Hamed Class: D ID Status: None Mohamed EI Address: 1516 CRESCENT ST Audit #: 5813386 DL Status: VAL Issue Date: 02/22/2012 CDL Status: None City/State: IOWA CITY, IA 522402137 Expiration Date: 08/08/2016 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 1516 CRESCENT ST Restrictions: Corrective Lenses Restriction None Date of Birth: 8/8/1985 Supplement: Mailing City/State: IOWA CITY, IA 522402137 Sex: M History Information CLEAR DRIVING RECORD Name: Hamed Mohamd, Hamed Mohamed EI DL/ID: 565AG4232 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: -•:f�i��y 7/28/2012 IOWA ?' D. 0. T. f �A S� Office of Driver Services SDR Iowa Department of Transportation Name: Hamed Mohamd, Hamed Mohamed EI DL/ID: 565AG4232