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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040 CA41-
(319) 356-5497 FAX
WED. i(VgZIL 3
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
l3- B I
(Office Use Only)
First Middle Last ff
1. Name X14 �n ryt n 1 A M a to a Y�IC d
2. Mailing Address 729 E ND AVL Go kA L V I L: E Z A 5 9-2-141
3. Telephone: Home 319 - Ll 00- 611% Other.
4. Prior experience in transportation of passengers: t
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense Where When
NO
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? N o
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? r� O
Type of offense Where When
8. Has your drivel's license or chauffeur's license been suspended or revoked in the last five years? N u
Tvpe 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) N 0
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 herebyy certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
l�a�n ty�e v� A Mo�nnmc d 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, 1 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
OH- 10- t3
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STATE OF IOWA )
COUNTY OF JOHNSON )
Sins ribed and swRrn to,�efore me by M Ck `M O V-A " `'ILl M CJ . On this ) day of
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).
OghaturO& Police Chief or designee
;'-/e -/ 3
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.
,,) -e.
Signa&ire of City Clerk or designee
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 51/2"
(height) and prominently displayed to all passengers.
+HHH++++++++++++H++++++++++H+++++++++H++++H+++++++++++++++++++++++++++H+++++++H+H+++++++++++++++++R++H++H+++++H+++f+f++++++++++++H
Office Use Only
Approved application
DCI report
State certified driving record
Website update
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Iowa Department of Transportation
Office of Driver Services (Tali Free) SOU -532-1121
PO Bou 9204, Iles Moines, IA 59306-9204 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
3/13/2013
DL/ID #:
669A72746 (IA)
Name:
Mohamed, Mahmoud
Class:
D
Address:
729 E 2ND AVE
Audit #:
6692746
Restriction
None
Issue Date:
02/13/2013
City/State:
CORALVILLE, IA 522412201
Expiration Date:
01/01/2018
Endorsements:
3
Mailing Address:
729 E 2ND AVE
Restrictions:
NONE
Date of Birth:
1/1/1977
Mailing City/State: CORALVILLE, IA 522412201
Sex:
M
History Information
CLEAR DRIVING RECORD
Name: Mohamed, Mahmoud DL/ID: 669AJ2746
Customer #:
6063417
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
Page 1 of 1
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:
........'�/d;'4�
3/13/2013
IOWA
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Office of Driver Services
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Iowa Department of Transportation
Name: Mohamed, Mahmoud DL/ID: 669A72746
3/13/2013