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Home My WebLink About12-181A First / Middle Last ff- 1. Name hm P!�,lt A14q 46C4 hhrl C -I 2. Mailing Address .2qO 1 /T� y �E APt yC141 1O W 0 e� 3. Telephone: Home 7is2— I / 2 6 Other: 4. Prior experience in transportation of passengers: tC/, 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Al' � 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 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? IVl5 Type of offense Where When 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? /VD 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) 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) d dmmady 06/2012 /0L -121 Authorization Number r • _ 1 (Office Use Only) ► MIIr®r�� 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 8)23 56-5040 5497 FAX A First / Middle Last ff- 1. Name hm P!�,lt A14q 46C4 hhrl C -I 2. Mailing Address .2qO 1 /T� y �E APt yC141 1O W 0 e� 3. Telephone: Home 7is2— I / 2 6 Other: 4. Prior experience in transportation of passengers: tC/, 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Al' � 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 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? IVl5 Type of offense Where When 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? /VD 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) 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) d dmmady 06/2012 I hereby certfy that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license nufnber T# �i �7 �i�iy �B . 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 timesv�ith 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 % 9--12- STATE (%_ STATE OF IOWA ) COUNTY OF JOHNSON 1 scribed and swouS4 -1 to)bgfore me by AkQ� N&0— . On this /-��f - day of �(� L_ -( ,-e, X �f f I .vaN - I KELLIE K. TUTTLt _��,,, o. �u�� ., �. A s... !tie Qf�#e .,a i..,.,� My 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). gnatur of Police Chief or designee � 71r. Sign ure of City Clerk 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 Identification cards. ft###4#44#444#IRRRRRIR1f#RRfR1Rf111HR1MY#HYflMffYYf###f#ffft##tftfiftftl4*#4fiRR##f#44#f#4Hf#44###:F#4R1f#RR1##MR1f1ff1111R11f11ffYfffh4f#Y Office Use Only Approved application DCI report State certified driving record Website update aedvww;vefdgeazo10.doc 06/2012 Iowa Department Office of Dover ServicesIA 50300 -9204 p0 Box 9204, Des Milnes. A Certified Abstract of Driving Recor Inquiry Date: 8/17/2012 Ahmed All Elleislr Name: Mahnna, 2401 HIGHWAY 6 E APT Address: 4814 ID status: IOWA CITY, IA 522406795 City/State: D622 DL status: HIGHWAY 6 E APT Mailing Address: 48014 Mailing City/State: IOWA CIN, IA 522406795 of TranSportafion (Toll Free) 800-632-1121 515-244-9124 FAX:515-239-1937 History Information CLEAR DRIVING RECORD Name: Mahnna, Ahmed Ali Ellelsir DL/ID: 587AH8909 Na that I an the nook oDirector of f Driver Servkes, that ver Services, true and accurate copy of an official record currently In the custody o Pursuant to nooP the drecmds held by Kim Snook, he Director of Office Iowathis Department of Transportation rtat on to so certify,epartment of ation, do hereby certify the custodian said office, and that I have been authorized by 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 /41' 8/17/2012 Customer #: 5941033 DL/ID #: 587AH8909 (IA) ID status: None Class: D622 DL status: VAL Audit#: 1:448 CDL status: None Issue Date: 08/16/2012 CDL Cert Status: None Expiration Date: 01/01/2017 CDL Med Status: None Endorsements: 3 Restriction None Restrictions: NONE Supplement: Date of Birth: 1/1/1963 Sex: M History Information CLEAR DRIVING RECORD Name: Mahnna, Ahmed Ali Ellelsir DL/ID: 587AH8909 Na that I an the nook oDirector of f Driver Servkes, that ver Services, true and accurate copy of an official record currently In the custody o Pursuant to nooP the drecmds held by Kim Snook, he Director of Office Iowathis Department of Transportation rtat on to so certify,epartment of ation, do hereby certify the custodian said office, and that I have been authorized by 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 /41' 8/17/2012 10WA ': *'' V D. 0. T. j �f,..... . �.. h9lVE -- Office of Driver Services Iowa Department of Transportation Name: Mahnna, Ahmed All Ellelsir DL/ID: 587AH8909 Aug.24. 2012 3:07PtJ� aug. If. tu12 L. uJIII y��F•"ul4 a�� :�1 s IaVfl� �F1 Div of Criminal Investigation �I t bI e I K - u ly u IUTfd �'I ly STATE, ®IC'IOWA (CximinalHiRtotr;y-Rceord (Check Request Form To: Iowa Divisfou of CrIminal Investlgatlon support OperaHorls Bureau, VFlo or 215 K. 7°i Street DuMolnes,Iowa 50319 (Bi5)725.6066 (515) 725.6090 Fay Nu.0863 FP. 2 DCIAoaount24-umbers '+DQ�Lf (ifapplieabl9) From, CITY OF IOWA CITY CITY CL1• RXIS OFFICE 410 M WASWNGTONSTA UT IOWA CITTt IOWA 82240 Phone:. 319-356-5041 Fax: 319356-9497 kwa Criminal History Record Check Regul%s Ag of 7 ,— a search of the prodded name and date of birth. revealed: ,� M? -13 U) Nolow4UrninalHistory Record fotandwithl)CI 1 = F 13 Iowa Criminal Matory Record aftached, D CI # CO DCI Il _. I T. • 41 AA A 11t11 11 ,/,Y