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Home My WebLink About12-179+ C"21Ilk CITY OF IOWA CITY 410 East Washington Street Iowa uty. Iowa 52240-1826 319) 356-5040 CA�� (319) 356-5497 FAX Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday – Friday.) / �2-i7 1 (Office Use Only) FirstAA Iddle Last If 1. Name - C X40 0,Pd 2. Mailing Address 2�i� p= ✓ R (3 3. Telephone: Home Other. J 4. Prior experience in transportation of passengers: c o 1-a -y— rte- Fn 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? f\/ 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?14 ()_ Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? V' � 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 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) cl.Ntardrvb dg 06/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 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% i STATE OF IOWA ) COUNTY OF JOHNSON ) S c r i bed an(J sworn to before me by (Y) l D ✓ e-Ov Tb r a__k r -On this ;ULVH °-- day of 2o)Z Notary Public in and for the State of Iowa #*#k4}**#*#********t###44*4}}4#k}#***********k4###44}##************##*#*###*###**#44#k4#####k}**#******#*****#**##**###*##*#tk#***********##*kkk 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). of Pblice Chief or or designee 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 Ident 9cation cards. Office Use Only Approved application DCI report State certified driving record Website update cled mIddmadgeapp2010.do 06/2012 Iowa Department Office of Driver Services PO Box 9204, Des Moines, IA 50306-9204 Inquiry Date: 8/24/2012 Name: Ibrahim, Mohamed Elsadig Address: 2504 BARTELT RD APT 2B City/state: IOWA CITY, IA 522462714 Mailing Address: 2504 BARTELT RD APT 213 Mailing City/State: IOWA CITY, IA 522462714 convictions of Transportation (Toll Free) 800-532-1121 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record DL/ID #: 257DD6818 (IA) Customer #: 4350508 Class: D ID Status: EXP Audit #: 6217135 DL Status: VAL Issue Date: 08/15/2012 CDL Status: None Expiration Date: 09/02/2014 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Restrictions: NONE Restriction None Supplement: Date of Birth: 9/2/1979 Sex: M History Information Citation Date Conviction Date ACD Explanation County ]UR78 IA 04/12/2009 04/29/2009 M81 Careless Driving 78 IA 04/12/2009 04/30/2009 S92 Speed Name: Ibrahim, Mohamed Elsadig DL/ID: 257DD6818 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify tnat >. 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: b7'•^•:'/Gj 41 8/24/2012 s ' *°'E 41P-97 D0WA . 0. T..-*ItW e4CV'1r-=k Or••••••' gt�'' RRIilEO,,= office of Driver Services i�� Iowa Department of Transportation Name: Ibrahim, Mohamed Elsadig DL/ID: 257DD6818 ,h g.21. 2012 3:38PM Div of Criminal Investigation lSTATE OF IOWA (Criminal History Record C-Weck z Requot Forma�Nr`_%. To; Iowa MOsion of Criminal I'hvestlgatiorn Support Operations Bureau,lttFloor 216 P. 7"' Street Deg Molnew,Iowa 50319 (515) 725.6066 (515) 71/3.6000 Fax C NNo,L01�03 PP. 42,2 DCrAcoountNumber•: mon a — F Qt'epyllcabla) Nromt CITYC OF IOWA CI Y CITY CLLRIIS'S OFFICA 410 E. WASkUKGTON STRUT IOWA CITY IOWA 52240 11houe; 319-356-5041 Fax; 319.356-5497 r Lq- i'.2 / n -7q I vmale. QxTe>nale 1/4-5 � 3 7S 'O'? � q WaiveY-7aform[[fioyt: Without a signed walver from the subject of the request, a complete criminal history record may not he rolonsable, per Code of Iowa, Chapter 692,2, For coMpiete criminal history record Information, as allowed bylaw, alut'ays IJ7a1Ver.R&(19e:lhucby giro pomritalott forlhe abova rzquasringoSlclal to eonductaa taw& criminal histeryrccurd ahwkwhh diobivialon alGYlminal rnyettigetlon(DCO. Anycrimtnalhhtory data concemrngmethat tonlelntainedbythobCtmaybotekascdasellowrdbyinw, Waher,iiymafure; Xowa Crimirw ffxstory Record (Check Results. As of C6 a Search of the provided name and date of birth revealed; No Iowa C'rimina.1141swy Record found with DC1 13 Tows Criminal History Roeoxd attached, DCI # DCI ?eceived Time -Aug. 15,..2012 2:37PM No. 1 rxocl p�anls) =-.� • rr tr. CD C.'�O V'tl�r_i c� a 70 r N I �U"AMED ELSADIG 2504 BARTELT Rn At IOWA CITY, IA 52246 DL h4.257DD6818 'ss 06!15/2012 EXP 091 A/; D Ena3 NONE ns DOB09/02/1979 DO 76217136giM13231402"14D USA IA