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Home My WebLink About13-265 Authorization Number (Office Use Only) III t 1,1 ingsmoRAPPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (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 (319) 356-5040 (319) 356-5497 FAX F1rst Middle _ Last 1. Name Rcl � _ / J /111/.) 1 2. Mailing Address �O `) F R O(C /*2J- f�I� At a /) Ja wc+ J /L�. t d 3. Telephone: Home <-7/ a 5-W? Other: J 4. Prior experience in transportation of passengers: 6-1 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 1-' 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? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? ! ` 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) //\(- 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) clerkftaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 60(40(. 4,j L, . I understand that if I falsely answer any questions in this application, that this application may be denied. 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 If(/ —9e)/7} STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by Kho f; cp A . A . Mc.,kc ., . On this l ?) 1A day of fin )e u.), lne .y ,--9Jt3 vo� icO 5 �•'''ist, WENDY S.MAYER Notary Public in art,for the State of I a� S Lommisslon NUmmer IZU4l8 My commission Expires ow '� I -I l C *****,,******* ********* ************************************************************************************************************************ 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). /i /9g 0-20/3 Sight re of Po ce C 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. -e. -- 42.4.4.-/ 1/- / 9- /3 Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width)and 5 1/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update cleNtaxidrivbadgeapp2010 doc 03/2013 .'x. Nov. 12. 2013 10:40AM ,Di vrof Criminal Investigation NT No . 1841 VUV PL P. 1/1 V .I I. [VI/ .I•l L I I.I V I l V 1 4 I n V I t, vi .V.I LL v I l �'� IOWA)3t,:3 Criminal History Record Check • _ . .;` .�r-JA ;e't� "equest Form "`';'': a.•\� des% /*v'/t,j civ` • DCI Account Number: try-0-J (if applicable) • Tot Iowa Division of Criminal lkkvestlgatloh From; CITY OF IOWA CITY Support Operations Bureau,1rtFloor CITY CLERIC'S OFFICE 215 EI 7th Street 410 E WASHINGTON STREET Des Moines,Town 50319 (515)7256066 I0i>A—CSX—I941A 52240 (515)725-6080 Fax Phone: 319-3565041 Fax; 319-356-5497 I am requesting an Iowa Criminal histol_Record Check on: . Last Name(mandatory) First Name(mandatory) _ Middle Namo(recommended) 414 r Datet /of Birth(mandatory) Gender(mandatory) — Social Security Number (recarnmendoe) 7 e , i / 1 `Male Fcmale Cl6 a! ( - 1a - <-a 71 JYaiverlriormalian:Without a signed walvor from the subject of the request,a complete criminal histotyrecord may not be releasable,per Code of Iowa,Chapter 692.2.For complete criminal history record information,as allowed by law,always obtain a waiver signature from the subject of the request. Aaaiver Release:Ihereby give permission for the abova_rcquesdngafficial to conduct an town criminal history record check with the Division of Criminal Invcsligatlon(DC)). Anycriminat history data concerning me Watts alntaincd 6y"xi Ct may be released as allowed by law.er n ,� Waiver Signature: s.a.— I kit Iowa L3,Criminal History Record Check Results Peluso only) As of J�`/e L , a search of the provided name and data of birth revealed: • • RNo Iowa Criminal History Record found with DCI • El Iowa Criminal history Record attached,DCI# - DCI initials_? ^ Received Time7Nov.,a,541/2013 3:52PM No. 4046 Page 1 of 1 In Iowa Department of Transportation Office of Driver Services (fon Free)800-532-1121 PO Box 9204,Des Moines IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving'Record Inquiry Date: 11/1/2013 DL/ID 0: 666A33549 (IA) Customer 7f: 6036513 Name: Mandl, Khalid All Ahmed Class: D ID Status: None Address: 2658 ROBERTS RD APT Audit ft: 6663549 DL Status: VAL 2D Issue Date: 02/02/2013 CDL Status: None City/State: IOWA CITY, IA Expiration 09/08/2018 CDL Cert None 522462743 Date: Status: Endorsements: 2 CDL Med None Status: Mailing Address: 2658 ROBERTS RD APT Restrictions: NONE Restriction None 2D Date of Birth: 9/8/1971 Supplement: Mailing City/State: IOWA CITY,IA Sex: M 522462743 History Information CLEAR DRIVING RECORD Name: Mandi, Khalid All Ahmed DL/ID: 666A33549 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: �yyq *FY�CIf..t) 11/1/2013 50 IOWA c:: )$�-y 1�� ‘,„„„,.....4c- rvices Iowa eDepartme Dof Driver epartment Transportation Name: Mandl, Khalid All Ahmed DL/ID: 666A33549 • 11/1/2013