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Home My WebLink About13-225 Authorization Number rip— (Office ij—(Office Use iiZ114210/11a. .wr®'�� 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 Middlq Last, 1. Name V1/1.4KA A�7r(c.3 Ft I.7 cc"--Y1 2. Mailing Address 2_60Z B,1-41-e 0' V p S 221-46 c‘-tej , A 3. Telephone: Home 4. Prior experience in transportat' n of,passt<,pgers: 'C • ,n21:i a 11404#:Wii4i7' 7t 5. Have you ever been convicted y isdemeanors and/or felonies in this State or elsewhere? 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? NC 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? Ab 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) • clerWtaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number '73 7 A22g 5 g . 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 wit 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 /ZC 6/ 2Ot 3 ************************************************************** ****************************************** ************************************ STATE OF IOWA ) H o avvk �. � f l , COUNTY OF JOHNSON ) 910Z 'SZ rnr sal!dx3 uoissuwo C� i& Subscribed and sworn to before me by EZS6LL JaQwnN uois W On this /� I�Jay of Apr "Di -IeaS ieueloN I1Y1I 13l1WYS 03WyyyHQW / • . -i- a o;` gip/ 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). /hr� .7 -/� Signature of Police Chief 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. • k44--/ /a 1,3 Signat 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 '/z" (height)and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update derk/taxidrivbadgeapp2010.doc 03/2013 Ser, 19. 20131 12: 38PMi Div of Criminal Investigation No. 8328 P. 5 -•r1.,J. cv 1J I JR� 1 v1lJ V14111 Vlly UI 1Vna Vlly No. J011 F. I It%1 C � )l13 ' f:IH, 'i.3/ Request Fortin : T��:�� • • • DCT Account Number: tc�pnaaDle) Brom. city Clerk's Office To; Iowa Division of Criminal u,Investigation 410 E, erk's an Street Support Operations Bureau,in Floor 215 E.15h Street • Ties Moines,ion 50319" Iowa Ci , a521A0 (515)125-6066 (515)125-6080 Fax - Rhone: 319-__ 356-00 Fax; 319-356-5497 I.ainte.uestin:anToWaCriminalHisto Record Checkont Middle Name �e�ommended) Last Name(mandato First� `Name(mandato ) 0'14 CLS SU'YI - , ,i'^A/oLS Se''IW` Gender(mandato Social sCCUI'' Number (recommended DatO�IO�,/T�1iYtll (meadaloty) ii VkI •�� -3 `, tU ( J /1c� 3L71►1TaIe Female a complete criminal history record may not Waiverelreleasable, perCode:of Iowa,Chapterithout signed6924.waiver from the subject thehistory request, law,always ba releasable, Code 692.2 For com let criminal history record Information,as allowed by Y obtain a waiver si:nature from the sue ect of the re 1 uest. record cDedc whit Ma blvlslon or Cambial CI An aMaorydatacontamingmethuti amps`iedbythe Denney bereleesedofallolwedbylaw. Waiver Release:Thereby gluapetmission for the above requesting official to conduct an Iowa criminal ,s ory investigation(D )• Y odmint , .A . — � i _ Waiver Signature: how Criminal ITist Record( Cheek Results (DCime only) • As of di 1� a search°file provided name and date of bftth revealed: • • FNo Iowa Criminal History Record found with DCI ' 0 Iowa Criminal History Record attached,DCI#,_________— • DCI initials__! ' Received Time—Sep. 13. --2rO1i 4:31PM No, 7508 vvnr'l't 1u '1Sltn, inkIowa Department of Transportation Office of Drug{Sorytces (Toll Fine)WO-5321121 PO Box 0204, Ues Moines, IA 50130&11204 } :516-239-18374414 Certified Abstract of Driving Record Inquiry Date: 9/26/2013 DL/ID #: 737A32858 (IA) Customer#: 6144285 Name: Elhassan, Elwaseela Class: D ID Status: None Ahmed Mohamed Address: 519 2ND ST SW APT Audit#: 7375281 DL Status: VAL 3 Issue Date: 09/25/2013 CDL Status: None City/State: CEDAR RAPIDS, IA Expiration Date: 09/10/2018 CDL Cert Status: None 524042129 Endorsements: 3 CDL Med Status: None Mailing Address: 2606 BARTELT RD Restrictions: NONE Restriction None APT 1D Supplement: Date of Birth: 9/10/1983 Mailing IOWA CITY, IA Sex: M City/State: 522462729 History Information CLEAR DRIVING RECORD Name: Elhassan, Elwaseela Ahmed Mohamed DL/ID: 737A32858 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: %4 Tiff‘hhi 9/26/2013 ,3. D. O. T 'w' hi limit Office of Driver Services tt0. hvw Iowa Department of Transporation Name: Elhassan, Elwaseela Ahmed Mohamed DL/ID: 737A32858