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HomeMy WebLinkAbout13-238 I . Authorization Number ! 3 i (Office Use Only) tAIMIN1 •=11. III MWI® 1:41r CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (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 Firrst J Middle / Last 1. Name Oa 1/1 14 0 Gl.b► /} /tteLl'UDSSJ 2. Mailing Address Zer Elf Rey c &I .# 2 A 3. Telephone: Home 319 -3 3/ r„i,3o Other: 4. Prior experience in transportation of passengers: • 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? n10 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? A/U Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? ifb • Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? A1L" 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) /✓0 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) clerkttaxidrivbadg 03/2013 1 4.s r 4 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number' 1- f -7 A�- 5- 0.1.4 . I understand that if I falsely answer any questions in this application, that this applica ion 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) ,/��i /�j /� Signature of Applicant ./(1-‘"'v Date /(/ "U"( ,-,3 STATE OF IOWA ) COUNTY OF JOHNSON ) S cribe�d,and sworn to_before me by 17/�� MO ad r E.I/170 c )-:, . On this T�4' day of Oc-t 7---,,A, KELL►E K.7—b E- t-6 /Gc-t(-" if 're rnmissio'Nu er22181' ;Z`P m otary Public in and for the State of Iowa My o�� ,r� ****************************************************** **********:****************************************************************************** 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). 4„/„, gnature of Police Chief or designee ate • 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. -7;i 1 ) . -e---47.4 ,_/ /, - `f- /3 . Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2"(width)and 51/2" (height)and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update derklfaxidrivbadgeapp2o10.doc • 03/2013 ,Se;,J..27. 2013 9: 27AM (Div of Criminal Investigation. No 7470 P. 2/3 V"tn L ,. LVID L. LJom1� v 1 I. L. STATE OF IOWA �� Criminal History Record Check •i;k . .• .a4,' Request Form met Account Number: i0b (if applicable) To: Yowa Division of Criminal Investigation From: CITY OF IOWA CITY Support Opera Hens Durenu,1"Floor CLT? CLERIC'S OFFICE 215 E,7t Street 410 E WASHINGTON STREET Des Moines,Iowa 50319 (R5)125-6066 IOWA CITY SO JA 522%0 (515)725.6060 Fax Phone: 319-3565041 Fnxt 319-956-5497 I am requesting an Iowa Criminal Ristory Record Cheek on; Last Name (mandatory) )(grist Name(mandatary) Middle Name (recommended) . cLho sir MAW \ f) fitAmncd Mc41\no a Date of Birth (mandatory) Gender(mandatory) _Social Security Number Occomnrcndcd) 02-- 2--\ k%7 Male ❑Female 1D1— \ I (75 Waiverin,/ormation: Without a signed waiver from the subject of the request,a complete criminal history record 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, WaiverRelease:t hereby give permission for Ike above rcquesllne oftielal to condnot an lows orlminal history record°heck with the Division otcriminal Inv:sligation(DCO. Any criminathisrory data concemin malilgt is mainrolnod bytke PCl may be released as allowed bylaw. Waiver Signature: / f7iIowa Criminal History Record Check.Results (pCtuseonly) As of 0 6Iril 1 L� , a search of the provided name and date of birth revealed: W No Iowa Criminal history Record found with DCI • ' 0 Iowa Criminal History Record attached,DCI# _ ACI initials_ 6 DCT-77(05125/10) • Received Time Sep. 24. 2013 2:24PM No. 7157 t11 lova Department of Transportation i : Office of Driver Services ( oa Free)800-5532-1121 PO Box 9204,Des Moines,IA 50305 92[14 515-244-9924 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 10/3/2013 DL/ED #: 457AF5304 (IA) Customer#: 5735973 Name: El Hossiny, Mahmoud Class: D ID Status: None Ahmed Mahmoud Address: 2654 ROBERTS RD APT 2A Audit#: 6856868 DL Status: VAL Issue Date: 04/11/2013 CDL Status: None City/State: IOWA CITY,IA 522462741 Expiration Date: 02/12/2016 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 2654 ROBERTS RD APT 2A Restrictions: Corrective Lenses Restriction None Date of Birth: 2/12/1987 Supplement: Mailing City/State: IOWA CITY,IA 522462741 Sex: M History Information Convictions Citation Date. Conviction Date ACD Explanation County JUR 09/26/2010 10/18/2010 S92 'Speed ry .Iowa IA 06/01/2011 06/13/2011 S92 ;Speed (10 mph&under in 36-55 mph zone) Tama IA 10/27/2011 :01/20/2012 592 Speed Johnson IA Name: El Hossiny, Mahmoud Ahmed Mahmoud DL/ED:457AF5304 Pdrsuant 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: =QpFHICLf8/2k, .`O. 4o\ 10/3/2013 o' IOWA *'% or Ar 0� D.0 . 7 'tet ' ry'IO�4e© ,: $ y Office of Driver rtrnr DepartmentIow Name: El Hossiny, Mahmoud Ahmed Mahmoud DL/ID:457AF5304 :1 I: