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Home My WebLink About13-177 cl Authorization Number ` 3 — \1 I r 1 (Office Use Only) ""`-__. 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.) lowa(City, 1 52240-1826 ( 356-5040 j V)/0 (319) 356-5497 FAX Firsi Middle Last 1. Name 4,1 I? n Q ,4 Pct l'► H q 2. Mailing Address 4 21-101 H W/ AT- Mf f L j 3. Telephone: Home /ACll Other:f',/,a F rtc - 319 3 2 113 4. Prior experience in transportation of passengers: $1>6 �'rc i'S 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /16 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? o Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? / 0 Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? l W 6 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) /10 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) cIerk/taxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number ,Q(1.4S'4'o°F I understand that if I falsely answer any questions in this application, that this application may be denied. I un erstand 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) F, Signature of Applicant Date �5 i� ************************************************************************************************************************************************ STATE OF IOWA COUNTY OF JOHNSON ) Sues-, ribed and sworn to before me by F-4 10-14 170a--4 . On this "6-11-4\---' day of - ._o/ ' C ('r-C J /c-c //( �rAt_ m KELLIE K.TUTTLE _ otary Public in and for the State of Iowa "My issi n E pires 484 ************************************************** *** ***************************************************************************************** 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). 2�Z3 Signature of olice ief 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. i iii / ign:: ure 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 clerWtaxidrivbadgeapp2010.doc 03/2013 Page l of 1 Iowa Department of Transportation fs's Office of Driver Services (Toll Free)800-532-1121 PO Box 9204,Des Moines,IA 50308-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 8/9/2013 DL/ID it: 587AH8909 (IA) Customer It: 5941033 Name: Mahnna,Ahmed All Class: D ID Status: None Ellelsir Address: 2401 HIGHWAY 6 E APT Audit It: 6220448 DL Status: VAL 4814 Issue Date: 08/16/2012 CDL Status: None City/State: IOWA CITY, IA Expiration 01/01/2017 CDL Cert None 522406795 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 2401 HIGHWAY 6 E APT Restrictions: NONE Restriction None 4814 Date of Birth: 1/1/1963 Supplement: Mailing City/State: IOWA CIN, IA Sex: M 522406795 History Information CLEAR DRIVING RECORD Name: Mahnna,Ahmed All Elleis'r DL/IG: 587AHE909 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: S"itinat •.. �7G/� 8/9/2013 ?* IOWA *ss %CatD. O. T. v h1j'a %..a rvices Iowa Department Office of Driver eof Transportation Name: Mahnna,Ahmed Ali Elleisir DL/ID: 587AH8909 8/9/2013 : Aug. 14. 20133i10: 111AM' •.Divrof Criminal Investigation),, ' , .. No. 3536 1• P. 2i3<4 • I 1 ' ..I.. •', • 'x .,;;1; , 'I . '. .., . I'I'I 'I 'I. '' i',' 1 ' • . .. c ;I „ •'I ' • 1 1' . , e l I •' Y , I I I I.. '. Y � • . .l . ' 'I 1 1 I I I• � .1 r ' , I I , 1 .1 ' I • p� r � �(\y }1,y(��!((! II��11((''(,11��II��{{f''�'1(I(I{,(1/T�I�(,�1\� 1 \. V)11' ,, ' I • ' JSP''•.l 1. . ', - 1 1,_. . }ST, .WA:! `LYl.' 'N-v \I /-+V, ' •• I •>4\4941•%/Y. /V,, j/P�: ' ' ''tUi�t l°• 4:II1 • r I idzuznal.JFR fiory. eeoletaCheek • ris si-Vr42 .r. 0:I` I 4 • .4•14,e . 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