HomeMy WebLinkAbout12-252CITY OF IOWA CITY
410 East Washington Street
Iowa C' 52240-1826
(31 356=5040
(319) 7 FAX
1. Name
2. Mailing
3. Teleph(
Authorization Number
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
4. Prior experience in transportation of passengers:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 41_
Type of offense Where When
/V O
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?__Idl�
Type of Offense Where When
T Have you been convicted of any traffic offenses in the last five years? N z)
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? tib
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
n
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)
derk4mdmo dg 09/2012
I hereby certify t at I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license numbel
d - /� � 5 � c.) CA . 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 / "�� ✓�i Date
STATE OF IOWA
COUNTY OF JOHNSON
Wscroeq and sworn to, �efore me by f t 10`Y`yVo l'i El go s") On this �2S ' "� day of
KELLIE K. TUTTLE
o@ Commission dumber 22187 otary Public in and for the State of Iowa
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).
1� /%la
Signa e f Poli ief or designee Date
YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY
CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org.
A -
SignaluMof City Clerk or designee
Taxi cab businesses are required to provide Driver Identification cards.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
io -/11- /a -
Date
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As of a search of the,Provided name and data of blithievented;
LJ No Ewa GSlniJna Tlistozykecord found with=
Iowa 0hufha1J 1afogRcooxd attached, I)CY
Received Time Oct. 5. 2012 4:39PM No -4735
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Iowa Department of Transportation
il 0 Office of Driver Services (Toll Free) 800-532-1121
PO Box 9204, Des Moines, IA 50306-9204 515-244-9124
FAX: 515-239-1837
Inquiry Date: 10/5/2012
Name: EI Hossiny, Mahmoud
Ahmed Mahmoud
Address: 2654 ROBERTS RD APT 2A
City/State: IOWA CITY, IA 522462741
Mailing Address: 2654 ROBERTS RD APT 2A
Mailing City/State: IOWA CITY, IA 522462741
Convictions
Certified Abstract of Driving Record
DL/ID #: 457AF5304(IA)
Class: D
Audit #: 5301129
Issue Date: 06/15/2011
Expiration Date: 02/12/2016
Endorsements: 3
Restrictions: Corrective Lenses
Date of Birth: 2/12/1987
Sex: M
History Information
Customer #: 5735973
ID Status: None
DL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
IA
Citation Date
Conviction Date
ACD
Explanation
County
IUR
09/26/2010
10/18/2010
S92
Speed
48
IA
06/01/2011
06/13/2011
S92
Speed (10 mph & under in 35-55 mph zone)
86
IA
10/27/2011
01/20/2012
S92
Speed
52
IA
Name: EI Hosslny, Mahmoud Ahmed Mahmoud DL/ID: 457AF5304
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:
.........
:'v/4� 10/5/2012
•IOWA ;''
1
D. O. T. j\
........ SR--
OIjI11f.R,,='
Office of Driver Services
Iowa Department of Transportation
Name: EI Hossiny, Mahmoud Ahmed Mahmoud DL/ID: 457AF5304
L
207 6TH STAPT 3 _
Co _4 ILLS, IA 52241
IPOLN.457AF53046
iss 0611512011 EXP ID End 3�B
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