HomeMy WebLinkAbout12-210l I r 1
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1426
(319) 356-5497 FAX
1. Name
2. Mailing
Authorization Number 19- a/
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday - Friday.)
3. Telephone: Home ;IT -' \ — to�) (4 4 Other:
4. Prior experience in transportation of passengers:v T-
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?. )y /o
Type of offense Where When
6. Have you be ry)Convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?
TVpe of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? .0 S
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 0
Type of offense Where When
9. Have you ever ad to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
7)
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« midrivc dg 06/2012
I hereby certify hat I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
L}� /t l 1 � 11 1: :�� . I understand that if I falsely answer any questions in this application, that this
app ication may be dered. 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) n
Signature of Applicant Date
STATE OF IOWA )
COUNTY OF JOHNSON
S ribedaand worn to before me by i Y'Or �11�?I� On this IJ day of
1_\ § nib
1 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).
Sign ture of Police GWf or designee
Signat1sre 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.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
derW idrlvbadg P2010.do 06/2012
Sep; 12, 2012 10:35AM Div of Criminal rInvestigation NNo.V.�3767 17 jPP, e6STAT.9 OF IOWA
S, i;�, � _ �.�' • • Crnsmaraal.]E3Glsta>1�� �@c�orr� �hccIs ,11opeat Form
TO, XosvaX)ivlsfo'nOCcrrhaalYrvastlgntfon
Support Oparattons 11urona,1'IkYoor
2Y5E, 7m Sirtot
baa hdytrfo9, Xom 50519
(515) 725-6064
(515) 925-60RO baS
I ani requesting: an Iowa
Chook
ob1�ornJe,pP Ctinodno,oWit
asYe>ao
htaaI0034blYksnature4-orhnyroq tahCtmahsppl�btinearacdt69soszYgt2ShYeeTrNoAor9ocUmoe
stCh.'e
�[Gt`YEY�i2�dlYS'E; IhucDygive permiss(on Lbr Illoabove 1'aqueslfngo0l�
rnvasrlga�fo4 (PCD..Uy eriminolltlslolydom adnJofil)n(fhlo IDntls mafntofno
WA(Ver
ACI el000tlntl4umber; *02-"-F
OropplConbte)
Pro ra r CTTY OF TOTZ& O12Z
CITY CLERK'S OMITOP
1RS
T06T�a u2k0
I'iTonoT 379--ASF—SOG.7 ,
I?0xI °.L° 35fi51s97 _�
'oeFn1 SeaixefivNumTr ar rr
Djeet of the regaes!-, q eomplals Ct•1r9faat hfsrory ra4arci ma)� noC
'orlminalhistoryrecorIIlnfotM4tloh, as allowed byl4tiw, alWgys
fo ronduolgt[Yo�w admlnnlfifslalyleaor4ohtckWil6lhaAticlenoPCominaf
V the A4lmay60 tokasad 07 AINW04 myMY.
Iowa CrxminaI Matory Record Check RestrYts .
r1s of /02— 1 a- asearch oflheprovided name and dato ofbiiih-revealed,
1�4J NOIbWO.Wn,i1,9History Record folmdwiith)DCT
Yowa OriminalMstoryRutord atfaohnd, DaYA
DOIinitial J_
Received Time Aug.31. 2012 3:59PM No.2585
_r_rocP,naonly)
:' Y:•
N
co
Iowa Department of Transportation
i 0 Office of Driver Services (Toll Free) ODD -532-1121
PO Box 9204, Des Maines, IA 50305-9204 515-244-9124
FAX: 515-239-1837
Inquiry Date: 8/31/2012
Name: Sharif, Mohamed All
Address: 1121 ASH ST
City/State: IOWA CITY, IA 52240
Mailing Address: 1121 ASH ST
Mailing City/State: IOWA CITY, IA 52240
Convictions
Certified Abstract of Driving Record
DL/ID #: 450AF6378(IA)
Class: D
Audit #: 6115230
Issue Date: 07/11/2012
Expiration Date: 08/17/2015
Endorsements: 2
Restrictions: NONE
Date of Birth: 8/17/1978
Sex: M
History Information
Customer #:
5729103
ID Status:
None
OL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
.Improper Passing
Citation Date
Conviction Date
ACD
Explanation
County
IUR
11/20/2010
02/15/2011
M34
,Fail to Obey TrafFlc Sign/Signal
52
IA
05/11/2012
08/14/2012
M70
.Improper Passing
52
IA
Name: Sharif, Mohamed All DL/ID: 450AF6378
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:
�"""•:/Ji �p
8/31/2012
IOWA` a°8�d
Y'.
D. 0.
'
fDAMP S =
Office of Driver Services
a.����-�
Iowa Department of Transportation
Name: Sharif, Mohamed All DL/ID: 450AF6378