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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
19) 356-5040
(319) .- 497 FAX
First /D u r yl,�� Middle / ,. / Last ( L�'Gk1 f VI
1. Name 4 l� i
2. Mailing Address 1631 60/ ii(le t II g !'o q ¢ 1'"y (A 522 G
3. Telephone: Home q $ 2 / C-4-1 c er Other: 3(g j 2J 7 'Z-
4.
4. Prior experience in transportation of passengers:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /V
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? we.,
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? A/
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Ac)
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) �, o
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)
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I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
-f 5 7
-6 / F 7- S 0 . 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 � -"-..__`�____--- Date O Z,z _ I?
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STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by 1t'1ohrn-4.42 T l cis--t{ 7 . On this J g day of
4, 6. .z. / 3 .
( 1a��m SONDRAE FORT ,L�� _ ••
Commission Number 159 ; Public in
h /oand for the State of Iowa
My Commission Expire-
w 3/71 c7 / ary
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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).
o-
Signatur f Police it is orr..esignee 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.
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Signature f Ci 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.
***********************************************************************************w************************************************************
Office Use Only
Approved application
DCI report
State certified driving record
Website update
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clerk/taxidrivbadgeapp2010.doc 03/2013
Aug. 20. 2013 12:00PM Div of Criminal Investigation No. 3135 P. 2/3
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Iowa Department of Transportation
,s Office of Driver Services (fall Free)800-532-1121
PO Box 9204,Des Moines,IA 50306-92+74 515-244-9124
IIIIPP FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 8/27/2013 DL/ID#: 465AF7080 (IA) Customer#: 5751120
Name: Elamin, Mohamed Bakri Class: D ID Status: None
Mohamed
Address: 1637 ABER AVE APT 8 Audit#: 6303343 DL Status: VAL
Issue Date: 09/14/2012 CDL Status: None
City/State: IOWA CITY,IA Expiration 09/13/2017 CDL Cert None
522464729 Date: Status:
Endorsements: 3 CDL Med None
Status:
Mailing Address: 1637 ABER AVE APT 8 Restrictions: NONE Restriction None
Date of Birth: 9/13/1962 Supplement:
Mailing City/State: IOWA CITY, IA Sex: M
522464729
History Information
Convictions
Citation Date Conviction Date ACD Explanation County JUR
10/09/2008 02/25/2009 _ ,S93 ,Speed i MD
01/08/2009 02/09/2009 M41 Improper Lane Use . - MD
11/16/2009 03/15/2010 -N31 'Fall to Yield Right of Way TM _ 4— ___ MD
11/20/2010 12/06/2010 ,N63 'Driving Wrong Way on One Way Street Johnson IA
04/03/2012 :06/08/2012 ?592 :Speed Johnson IA
Name: Elamin, Mohamed Bakri Mohamed DL/ID:465AF7080
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:
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8/27/2013
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Name: Elamin, Mohamed Bakri Mohamed DL/ID:465AF7080