HomeMy WebLinkAbout13-162 • Authorization Number /3 -- (6 �-
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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 't a va 52240-1826
(31 .-5040
(319) 356-5497 FAX
II Firstiddle Last
1. Name A blvvl et;1 I\- ESQ NAc, / a vv✓"1e(74
2. Mailing Address 2-S ep-14t { R )' , fl _A S 6r 6
3. Telephone: Home 3/9— �S�—�j I 7 t Other: ' f A
4. Prior experience in transportation of passengers:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? A' G
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/
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? /✓E 3
Type of offense Where When
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8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? AJc3
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)
clerk/taxidrivbadg 03/2013
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license'number
/ , fir 36 ? . I understand that if I falsely answer any questions in this application, that the
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 ti > with of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public)
Signature of Applican _.te l Date fit>/5/2_d ( 3
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STATE OF IOWA
COUNTY OF JOHNSON )
Scribed and sworn to before me by 1\"\ m 0 ��n this day of
ota 'ublic in and f•r the State of Iowa 1 3 14
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).
Signat e 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.
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 51/2"
(height)and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
clerk/taxidrivbadgeapp2010.doc 03/2013
..Jul. 26. 2011 4: 15PM Div of Criminal Investigation No. 1608 P. 8
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El rpcpgGSlminaMatozyRecord attached,DCIi? t
Received Time Jul. 23. 2013 12:59PM No, 00941 `
Iowa Department of Transportation
Office of Driver Services (Toll Free)800-532-1121
PO Box 9204,Des Moines,IA 50306-9244 515-244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 8/2/2013 DL/ID#: 519AG3626 (IA) Customer it: 5827626
Name: Mohammed,Ahmed Class: D ID Status: None
Musa
Address: 2425 BARTELT RD APT Audit#: 5729811 DL Status: VAL
2A Issue Date: 01/06/2012 CDL Status: None
City/State: IOWA CITY,IA Expiration 09/11/2016 CDL Cert None
522462709 Date: Status:
Endorsements: 3 CDL Med None
Status:
Mailing Address: 2425 BARTELT RD APT Restrictions: NONE Restriction None
2A Date of Birth: 9/11/1966 Supplement:
Mailing City/State: IOWA CITY,IA Sex: M
522462709
History Information
Convictions
Citation Date Conviction Date ACD Explanation County JUR
11/05/2011 41/30/2011 S92 Speed ':Johnson jIA
Name: Mohammed,Ahmed Musa DL/ID: 519AG3626
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:
Qe�** ***.4 i 8/2/2013
%,4.: IOWA .01*
vv.D. O.T. le0
Nuf**BYEA \.
Iowa Department of Driver
rtmr teryTransportationies
Name: Mohammed, Ahmed Musa DL/ID: 519AG3626