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Home My WebLink About12-1585. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Q r1 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?r.,A C) Tvpe of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? -r'i—o— �z Type of offense / Where When 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? r Tvoe 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) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND SJAJE 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) den widrivbadg 06/2012 Authorization Number /a2 — 4moi l 1 (Office Use Only) 4k,' l 104 10 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.) Iowa City, Iowa 52240-1826 (319) 356-5040 (3 19) 356-5497 FAX First Middle t / 1. Name H01-2, Sct�ej e aWL_ 2. Mailing Address 2-57 42 r� e�� 1E? 2{� -•o i.), C 1• 1 l A 3. Telephone: Home Other: 09 — 331 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Q r1 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?r.,A C) Tvpe of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? -r'i—o— �z Type of offense / Where When 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? r Tvoe 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) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND SJAJE 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) den widrivbadg 06/2012 I hereby certify that I hra�ve issued to me by the Iowa Department of Transportation a valid Chauffeur's license number- 3,,5.- A L— ro 1 a T . 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) p Signature of Applicant Date ++++++++++++++f++44#*}+##}}+++#+*#+}*+****+****f****+f*****#f+*ff*f***+f***1f****f***f#*}##**+*f***#*}*f}##+}#**}+++++++++*f+++++f++++++++++f+++ STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by 'Mc <"� %�!A o w w On this day of Nota Pu lic in and for the State of Iowa 713114 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). S' ature of Police Chief or designee �-/ - A�f� Sign re of City Clerk or designee -9-iz_ Date Date NOT VALID UNTIL Police Chief 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. #4#}###4i#*##4}}**4#**4#*ff**#f*fff*111111f11fffffffffllHffY#1111#!fff##f111ff41f1f1ffffflfN*flffff#f1H#1f###'###!11#11#*}#f#####**#*i***#}f*} Office Use Only Approved application ✓ DCI report �— State certified driving record Website update de4flaxidrivbdge 20104 06/2012 J Iowa Department of Transportation Office of Driver Services (Toll Free) 800-532-1121 PO Box 9204, Des Manes, IA 503D6-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 8/1/2012 DL/ID #: 315AE6704(IA) Name: Elawad, Molz Sayed Class: D Address: 2510 BARTELT RD APT 2D Audit #: 5907336 None Issue Date: 04/06/2012 City/State: IOWA CITY, IA 522462716 Expiration 01/02/2014 Speed Date: IA 09/17/2011 Endorsements: 3 Mailing Address: 2510 BARTELT RD APT 2D Restrictions: NONE Date of Birth: 1/2/1969 Mailing City/State: IOWA CITY, IA 522462716 Sex: M History Information Convictions Customer #: 5460751 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD Explanation County IUR 06/27/2009 07/21/2009 592 Speed 52 IA 03/11/2010 04/22/2010 592 Speed 52 IA 09/17/2011 10/10/2011 592 Speed 52 IA Accidents - Accident involvement Indicated does NOT mean the Individual was at fault or given a citation. Accident Date Case Number IUR 10/31/2010 599546 IA Name: Elawad, Moiz Saved DL/ID: 315AE6704 Pursuant to Iowa Code 4321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that 1 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, 1 have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: Name: Elawad, Moiz Saved DL/ID: 315AE6704 `�Q,..........,D/p �y 8/1/2012 ;ter IOWA ::% i% °' -j�i � /� j ED'S �C�:OF`DOIVFN �e IoOffice waeDepartme Department Transportation PA AAueg. 6. 2012 2:40PM CDiv of�Criminal I& VILrInvestigatioUI IVWa � �No.7391 O. LU)LtPP.�4/4 To: IonaDivision of Criminal Investigatlon Support Operatlons Bureau, let Floor 2151:. 7th Street besMoines,.Iorva 50319 (515) 725-6066 (515)725-6080 Fax Iamreauestinvali. owa(liminaIidistnrvRecnrdChecknn: DCIA000untNumbev If O 0 -:� , (~ (Itappllmblo) From: CITY OJ? IOWA CXTX CXT'Y CX-UAR's OXF10L 410P. WASHVI tTON'STIMM IOWA, CXTY XOWA 52240 Phone; 319.396.9041 Fax; 319.356-5497 Laat. Nabil) (mandatory) Fist Name (mandatory) Middle Name raomrnmde Iowa Criminal Hiso ry RecordCllecl�Result (D Date of Birth (mandntoty) Gender mandato) Social Security Number moommondm) \ , 2•'' \ O'\ (0 `'1 tgmale ElFemalo 2—d 1 ^ 7 b — ( L+ 7 WaiverWOPMa[foJt: 'Without a sipedwaiverfrom the subject of the request, a complete criminal history record may not bo releasable, par Codo of Iowa, Chapter 692.2. For co_ mnlete criminal historYrecord information, as allbwed by taw, always obtaInawalyorsignature from the subject of the renest. Waiver lzereasa: l waby 81wo ptnllhslon fo(dl6 abowo requesting official to conduct an Iowa erimInel history reord checkwilh IN Division orCriminal lucatigation(DO). Myalmhml liblary dole oonvunlagrno lhatislnarn(a(ndd byth DCl may be released a a allowed bylaw. Waiver Signature: Ili —i r, DCI Received TimeTAug. 1.1(2012 3:38PM No. 0647 Iowa Criminal Hiso ry RecordCllecl�Result (D qra , anlr) U) As of f , a search o£tho pToVlded name and date of birth revealed: <T Moo ;7 —i r, No Iowa Criminal History Rocord found with D CI Iowa Criminal Histov Record attached, DCI # �9 t' , ro o � DCI Received TimeTAug. 1.1(2012 3:38PM No. 0647