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Home My WebLink About13-228 Authorization Number /7j-a --S p k 1 (Office Use Only) II APPLICATION 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 First LCi Ili !J Middle �� p , Last AI �rS , /^1. Name J� !/ L � ri(1 .i1 �i�i-�( 2. Mailing Address 062 ,C�G Y �'f Ifs ,'J f� -C , .-O�L'Ak C i T-t LA- �2-z)-( 3. Telephone: Home , c):)..----- 33— t g q Other: 4. Prior experience in transportation of passengers: t A3YAMt YoM3VY �'4 + uVi nciaa 1 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or e g ' ,,,.,,,,,;, ,101! 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? NO Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years?- At(, Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? rJ(9 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) ,V0 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) clerkltaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number "166 A -"ci 1,5'4 . 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 2—Ol STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by caKic-lLF,_14 j K S-ctOn this a 1kJ day of 4.1141 WENDY S.MAYER otary Public in d for the State of a • OM ll • nim- Expires **************************************************k**.******************************************************************************************* 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). (7- Sig ature of 'olice of 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. Signa q—��-l5 Signa re of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 'h" (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 derWlaxiddvbadgeapp2olo.doc 03/2013 ,Sep. 27. 2013 9: 27AM Div of Criminal Investigation No 7470 PP. 3/3 } STATF OF IOWA • W`�'''n- `/r ' \', Criminal History Record Check • • •. "1 . 4 laivn'i) -1' 1 .,. A/, Request Form . • . ' DCI Account Number: t•J pcQ.-r Orapplicablc) To: Iowa Division of Criminal Investigation From: CITY OF IOWA. CITY Support OperationsBureau,t"Floor t•I Y CLERK-LS OFFICE Z15 E.7'h Street 410 E WASHINGTON STREET Des Moines,Xowa 50319 • (515)125-6066 IOWA CITY IOWA 51240 (515)125-6080 Fax Phone: 319-3565041 Fax; 319-356.-5497 I am requesting an Iowa Criminal HistoixRecord Check on; . Last Manic(mandator)). First Name(mandatory) • MiddleName(recommended) MUsr1rF9 K ALL ELbi6N Date of Birth (mftnaLot) Gender (mandelory) Social Security Number(femmmended) �MMale DFemale 021)-- 5 -ca-& ` Waiver I"nfonnatiou:Without a signed waiver frror11 the subject of the request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 6912.For complete criminal history record Information,as allowed by law,always obtain a waiver signature from the subject of the request Waiver Pekoe:i hereby give permission for the above requesting official to conduct an Iowa criminal history record checkWith the Division of Criminal lnvesllgadon(DC0, Any criminal history dale concerning me bat Is maintained bytheDU may be released as allowed bylaw, • Waiver SYgnature: Iowa Criminal History Record Check Results (=use only) 11-1 l As of 01 I Z 111)D , a search of the provided name and date of bitch revealed: . • No Iowa Criminal History Record found with DCI El Iowa Criminal History Record attached,DCI# • • DClinitiats • DCX-77(08/25/10) • Received Time Sep. 24. 2013 1 : 16PM No. 8829 i Iowa Department of Transportation .Y. Office of Driver Services (Toll Free)800-532-1121 PO Box 9204,Des Moines, IA 59306-9204 515-244-9124 114.11. FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 9/24/2013 DL/ID#: 733A39154(IA) Customer#: 6142527 Name: Mustafa, Karnali Eldien Class: D ID Status: None Address: 2602 BARTELT RD APT Audit#: 7349572 DL Status: VAL 1C Issue Date: 09/17/2013 CDL Status: None City/State: IOWA CITY,IA Expiration 09/18/2018 CDL Cert None 522462727 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 2602 BARTELT RD APT Restrictions: NONE Restriction None 1C Date of Birth: 9/18/1975 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522462727 History Information CLEAR DRIVING RECORD Name: Mustafa, Kamall Eldien DL/ID: 733A39154 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: 1''EHIIOCIA%1 .. *. 1! 4 . ..4%, 9/24/2013 .o: io: = ;D. O. T. :c% /h,1, 4�f ORIYEt ca_r/' OffIcef Driver Department Transportation Services • Name: Mustafa, Kamall Eldien DL/ID: 733A79154