HomeMy WebLinkAbout12-220�r'lll�
CITY OF IOWA CITY
410 East Washington Street
Iowa Citx, Iowa 52240-18?6
356-50q t J--
(319) 356-5497 FAX
1. Name
2. Mailing
Authorization Number \ 1- a a C
(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 �3c)- 533-6-p4cc) Other: —
4. Prior experience in transportation of passengers: fiQ24:5tft C -Q 14 / /o Q /5
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /1lh
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? /L&5
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? d` 1 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? /1�4
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 r'ERDEIED
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)
derkhaxidrivbadg 06/2012
I hereby certify thaw have issued to me by the Iowa Department of Transportation a valid Chauffeur's license numbei,
Z/ 6Z 6 /- 4 �/ 2 . I understand that if 1 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 tom- Date /Z
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by o� 4 ti Ati QA\� ��� �` �., On this �� _ day of
Ste. a�avrbe: ao �2 .
in and
713114
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).
P]l
of City Clerk or
9-a 0 -
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
ded idnvna app2010.da 06/2012
Sep -19, 2012 1O:18AM Div of Criminal Investigation
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1XX
Received Time Sep. 5. 2012 11:39AM No, 2708
(»G wo only)
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Iowa Department
�I
Office of Driver Services
PO Box 9204, Des Moines, IA 50306-9204
Inquiry Date:
9/13/2012
Name:
Taha, Mohamed Ahmed
CDL Cert Status:
Elmandl
Address:
2532 BARTELT RD APT 2C
City/State: IOWA CITY, IA 522462720
Mailing Address: 2532 BARTELT RD APT 2C
Mailing City/State: IOWA CITY, IA 522462720
of Transportation
(Toll Free) 800-532-1121
515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
DL/ID #: 462AF4812(IA)
Class: D
Audit #: 5613128
Issue Date: 11/04/2011
Expiration Date: 11/04/2013
Endorsements: 3
Restrictions: Corrective Lenses
Date of Birth: 3/16/1965
Sex: M
History Information
CLEAR DRIVING RECORD
Name: Taha, Mohamed Ahmed Elmandl DL/ID: 462AF4812
Customer #: 5746715
ID Status: None
DL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
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:
........... '�9op 4rr
9/13/2012
IOWA }9
�f S�Q
Office of Driver Services
RRIVER
N,����,,,;
Iowa Department of Transportation
Name: Taha, Mohamed Ahmed Elmandl DL/ID: 462AF4812