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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040 CA,
(319) 356-5497 FAX
First
1. Name
Authorization Number —! 9 7
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday - Friday.)
�� ofly (a FTJ-I 41Jtran3
2. Mailing Address2�J<Ob e✓75 jk[) A 4) 1 -ff I f`7
3. Telephone: Home Q70 G - 2,.5-2-L- Other: 54MC
4. Prior experience in transportation of passengers: P.d ✓'S
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Aio
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? g c
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? N b
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)
N U
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)
dwkft.dl�g 06/2012
511ur(G511(I
I hereby certify that I have issue 1O me by the Iowa Department of Transportation a valid Chauffeurs license n9amber
�Pi y/ S Iq u S R MMG� 1 understand that if I falsely answer any questions in this application, that thiF4
appli ation 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 qZ—
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by �or1S���o m��,o\v\nma. On this day of
ublic in and for the State of Iowa -71-hi 14
ff*44*4#tk#t#kkRt##ttt#3Rtftif RR*#Rifk4#*4it#Rk*R**RR*RR**R*###k***#R*ki##k**#*#4**4###f*ff#1414444!1114#tot#tt4t#t44kft#t#**RR#t43*}*}t#Rk4tttt
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).
Siginya ure of Frolice Cliief or designee
/
Sign ture of City Clerk or designee
SG•go/a
r 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.
f#!****!!t**##*!i*!f#*#*!i!*fe*t*t!#!i#!!*f!!i*!!*!f***t**##*!H}**N*#**Y***Hff#f*Y#M1MM1fff!lM11f11ff11ffifll'fff!lltiflelffif!#lfffilfllNf
Office Use Only
Approved application
DCI report
State certified driving record
Website update
aerR idmroadgeapp2010 d« 06/2012
C
Iowa Department of Transportation
Office Df Driver Services (Toll t=ree) 800-632-1121
PO Box 9204, Des Manes, IA 5030&9204 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
8/29/2012
DL/ID #:
544AG5717 (IA)
Name:
Mohammed, Faris Musa
Class:
D
Address:
209 HOLIDAY RD APT 319
Audit #:
5999364
Restriction
None
Issue Date:
05/23/2012
City/State:
CORALVILLE, IA 522411134
Expiration Date:
02/22/2016
Endorsements:
3
Mailing Address:
209 HOLIDAY RD APT 319
Restrictions:
NONE
Date of Birth:
2/22/1966
—� Mailing City/State:
CORALVILLE, IA 522411134
Sex:
M
History Information
Convictions
Customer #:
5867187
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 JUR
08/20/2011 ,09/27/2011 ;F04 Seat Belt Violation 52 IA
Name: Mohammed, Faris Musa DL/ID: 544AG5717
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:
S.•""''•ZP9j,,p 8/29/2012
D.
0. T. �'%
:6i r
D. O.T.:�%
. ..... Office of Driver Services
Iowa Department of Transportation
Name: Mohammed, Faris Musa DL/ID: 544AG5717
Aug: 17: 2012 9;56AM Div of Crniminal !Investigation ANo,V.G9444 PP. fV7L4
DCI AccountMimber: dMr.,--r—
(IrapplImblo)
To: Iowa Division of CriminalTnvestigation Prom] CXTYOFIOWACITY
Support Operations Pureal" V Floor CXTY OV3MI9 OFFICE
215 L. 716 Street 410 E.' WASXIYNGTONSTRX&T
beslYIoines,Iowa 60319
(515) 725-6066 IOWA.CITY IOWA 52240
(515)725-6080 Fax
Phones 319356.5041
Fax: 919-956-9497
lam requesting an Iowa CYimiaalMs(olyAecoldMecicon:
Last&lne(mandeloryde
First Name Mtddlexame remnimeu
N6kaynmed ayl NIusA
Date of Birth (mandatory) / Gopder (mandate y 5acial Seeul'i 1Vtlmber (rcwmmenaed
02-12-2-1 9 (� � !Tale OFemale 1�32- ?2..3134
WaiVeY,IrtfoMadon: Without a signed waiver from thesubjectofthe reguest,acompletecrlmrnalbtstoryvocorhmayriot
he releasable, per Cade ofrown, Chapter- 692,2, Far cote let ei-lininal history record information, as allowed bylnw) always
obtain awnlversignature from thesubectofthe re ucst,
WQtYEY.iI'BreRSe:I hcrcbygiro pcm]ission forthe eboye reynesthg oelefel to cortdUct an]'ows uiminsl history record eheckwilh dw nlvbton of (.lfmfnel
InVrsagegon (DC]), Any almhfet hhrory dole eonremingme thac Isncd 6y tl]o AClroay ba released ay ollotred by laty,
Waiver' Sigr:nfure: �—�
o va Cftl al History Record Check Results rocr,�,,ly)
As of
tom.) ry
-- to
I� t� }- l
a search of the p1'ovided name and date of birth revealed:
WW
NoIowa c,•lminaj,FTistolyRecordfound withDCI
N >
® Iowa Criminal HistoxyRecoxd atiachje-d, DCI # r c ,
M11llitials ' ` act/)
Received ime Aub. 1.3i/12012 2:57PM No.1240