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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
1. Name MI,
First
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday - Friday.)
(Office Use Only)
2. Mailing Address 1.5;2 V- f) AYe App J,wo L', fY if} 62246
3. Telephone: Home n Other: 3 19 - 1!4&e� — 4621
4. Prior experience in transportation of passengers: 'a
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? J✓o o have W
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? 1JO
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? N D
Tvpe of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /V0
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)
rL r 1 iAWye nrt
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) The re-
port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli-
cation.
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
cl.N t.idni adg - 09/2012
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I hereby certify that 1 have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
M k� k P h" 4 . 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 2 al/1-3
STATE OF IOWA )
COUNTY OF JOHNSON ) I
-W15s 'bed and sworn to before me by Q— I �' toe �� On this ? Z day of
Ef I ?�
ti�Cr k� l r �Ce
i 3a�L� se KEL IE Numper 22 819 �-
a _ ) Notary Public in and for the State of Iowa
****************#*k***k*#*#****#*h**###*k#*****#**h***fi*fikfifihkfifikkfifikkfikkfikkkfikkk**k***********4#*4+#kRRR4kfifi4R#fifikRfifikfififihkfififi#fifikfifik*fi*k**kfikk
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).
Signatyr e o olir �/ ie 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.
Signa re of City Clerk or designee
Taxi cab businesses are required to provide Driver Identification cards.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
oz- --?- ��- -/
Date
.1.,M nidrwbadgeapp2010doc 09/2012
L
State of Iowa
Division of Criminal Investigation
215 E 71h St
Des Moines IA 50319
Ph. 515-725-6066 Fax 515-725-6080
Iowa Criminal History Record Check
Walk -In Request
Your name f4 ci e a
Address 15 Y V2
Ci /State/Zi wcj Cj,-1q22 46
Phone# 3) q- 4 C, o- G 6 S I-
Ram,rctino nn Tnwn criminal histnry recnrd check on:
Fill in all shaded areas.
Last Name Apel/ido (mandatory)
First Name Primer Nombre (mandatory)
Middle Name Segundo Nombre (recommended)
A6,>77Ed
M.�,l6
BYI-Q-J'
Date of Birth FechaNacimiento (mandatory)
GendeerGenero (mandatory)
Social Security Number (recommended)
o ( $11-
Lld'*Male []Female
Waiver Signature Firma (If the request is on yourself, please sign. If the request is on someone else, write N/A.)
DCI USE ONLY
Results
As of 8A-~ o, , �?
a name and date of birth check revealed:
_
Io record found
I
c'
❑Record attached, DCI #
-
DCI initials
—
Receipt
Number of requests x $15.00
per last name = Total amount $ 5 • D O
Method of payment: cash
❑money order El check # ❑MasterCard or Visa
Cardholder's name
Last 4 digits of MC or Visa
DCI initials
Credit Card Number # Exp. Date
Iowa Department of Transportation
Office of Driver Services (Toll Free) OM -532-1121
PO Box 9204, Des Moines, IA 5O3D6-9204 515-244-9124
FAX 515-239-1837
11114011
Certified Abstract of Driving Record
Inquiry Date:
2/19/2013
DL/ID #:
644AH7961 (IA)
Customer #:
5960577
Name:
Ahmed, Mandi Bryer
Class:
D
ID Status:
None
Address:
1527 ABER AVE APT 5
Audit #:
6447961
DL Status:
VAL
Issue Date:
11/06/2012
CDL Status:
None
City/State:
IOWA CITY, IA
Expiration
01/0112017
CDL Cert
None
522464704
Date:
Status:
Endorsements: 2
CDL Med
None
Status:
Mailing Address:
1527 ABER AVE APT 5
Restrictions:
Corrective Lenses
Restriction
None
Date of Birth:
1/1/1984
Supplement:
Mailing City/State: IOWA CITY, IA
Sex:
M
522464704
History Information
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date Case Number JUR
06/19/2012 691671 IA
Name: Ahmed, Mandi Bryer DL/ID: 644AH7961
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;
I
..."""• '
2/19/2013
IOWA
D. 0. T..--';:!
Office of Driver Services
IIf'gAg-
Iowa Department of Transportation
Name: Ahmed, Mandl Bryer DL/ID: 644AH7961