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Home My WebLink About12-170rrlW®r�� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX First 1. Name A oQa� Authorization Number IA -17D APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) Middle 2. Mailing Address X PP_ / d llL -ES' - l O 3. Telephone: Home 319 - 333 — rio 17 4. Prior experience in transportation of passengers: eS Last a A f4, C/'�.119 052242 Other: fV<o (Office Use Only) 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? N 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? /yz) Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? NO Type of offense Where When Y' O 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? YV0 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) V\/ o 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) deM1 Widriv dg 06/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number f of 417 . 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 / X-CaY Date A&– 115- – If STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by y i<4 'd&M,'L . 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). r '5�-igii Sig—nayture ofPolice Chief /oor designee Date Signathre of City Clerk or designee 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. Office Use Only Approved application DCI report State certified driving record Website update oierMt iddmad9eapp20 10 d« 0612012 ' Aug 6. 2012 2 : 3 9 P M to Aub. 1• LVIL J•J II III Y7 'p W l ✓9 +� Div of Criminal Investigation C,Iy VI c I a VI IY VI lOn6,bl k STATE OF IOWA Al Criminal.History Record Check Request Form To: Iowa Division of Criminal Investigation Support Operations Bureaa, lrt )?loon 21519.7' Street Iles Moines, Iowa 50319 (515) IM -6066 (515)725-6080 Fax C'ox I am reques6rig an Iowa CYiminal History Record Check on: No. 7391 P. 1/4 No. LU)Lt P. L DCT Account Number; 4Opa.—P (irapplioable) From: CITY OF IOWA CITY CITY CLERK'S ONNICF, 410 E. WA81fINGTON STREET IOWA CITY IOWA 522do Phone: 319.356-5041 Fax: 319356-5497 Lost Name (maadasop- b r'AWAIAC (mandstory) Middle Name (rewmmende V1iYl.v� /� W1�R✓ � Date of Birth (mandatory) Gender mandatory Social SeeulrityNumber remmmeaded) No Iowa Criminal history Record found �vjth DCl . <� trn o t ram IWltiVef ritf01'Ma1i0YY: Without u signed waiveriVom tho subject of the request, a complete criminal history record may not I ba reloasnble, per Code of Iowa, Chapter 692.2. Fm• co_ mnlet9 criminal history recordlnformation, ns allowed bylaw, always obtain a wa(Ver slenn tare from the sub feet of the request, Waftr,ReTease; Ihaft give pemsh5ion fir the above requesting official to conduct an to%Ya edmival hhtory rcw(d ch --Awl@ lit Division ofCrlminal investlgaslon(DC)). Any criminal history data comxmingme that is maintained bytha DCL may be released or allowed bylaw. WatversigY ature; Iowa Criminal History Record. Check Results (DCruse only) As of ` 6 " a search of the provided name and date of birth revealed: 1� N A Cn No Iowa Criminal history Record found �vjth DCl . <� trn o t ram N 40 0 Iowa Criminal history Record attached, DCT # o r DCIinitlals C) Received Time7Aug. 1.1(2012 3:38PM No, 0647 V Iowa Department of Transportation AO Office of Driver Services (Toll Free) 800-532-1121 PO Box 9204, Des Moines, IA 503( B-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 8/1/2012 DL/ID #: 585AH9417 (IA) Customer #: 5928772 Name: Ahmed, Ameer Mustafa Class: D ID Status: None Mohammed Address: 1545 ABER AVE APT 8 Audit #: 5968669 DL Status: VAL Issue Date: 05/08/2012 CDL Status: None City/State: IOWA CITY, IA 522464707 Expiration Date: 01/01/2017 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 1545 ABER AVE APT 8 Restrictions: NONE Restriction None Date of Birth: 1/1/1969 Supplement: Mailing City/State: IOWA CITY, IA 522464707 Sex: M History Information CLEAR DRIVING RECORD Name: Ahmed, Annear Mustafa Mohammed DL/ID: 585AH9417 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: �;c......;q/M .:Z 8/1/2012 :ot p D.. 0. 0. T.;. pf ••••••' S`'= Office of Driver Services Iowa Department of Transportation Name: Ahmed, Ameer Mustafa Mohammed DL/ID: 585AH9417 ;(V }_; t'r.. USA to °7'AEE AMEEBR GILSTAFA MOHAMMED 1545 ABER AVE AAT 8 IOWA CITY, W 52246 Cy ce. vo 585AH9417 Njfn 05/08/2012 cxa OV0112017 ci, D Ear 3 +flgi 5.10" nf?Q�� NONED0B01; /0969 'eyu ORO �Y� lV%�d D 653 160U 1WV. on ss�5escssnn+uovo+ouro '2-63-3't. 2-20)G �;) ( A- k"-4) C) U-tA *-