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Home My WebLink About14-222 Authorization Number if/ - 1 2- - l _ 1 (Office Use Only) .11 MO an APPLICATION FOR TAXI I MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday-Friday.) 410 East Washington Street Iowa City. Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) FirstNI,0.q) /� � Ailidstet(07 0Las�t p`ie,/)2. Mailing Address (REQUIRED) 26 2 Lc'a�-S AD -t ID ` (y 3. Contact Information (REQUIRED) Email: Oi QAArase1 0)AMENL-coi41CellPhone: hiq`4??-2/6e AS Q `� 4. Prior experience in transportation of passengers: J ��' (��c� C4) cid (/'e 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /1/,1 Type of offense Where When 6. Have you bge/n convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? /li() Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? "/'y' Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Gov Type of offense Where When :7n o 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please prov4Veche nnne(s)". , DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIEQ_ 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) 09/2014 I hereby ify tF1at I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number i�' W O g s . 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 / `"�0( �6� /v� '� Date /6/2 / 2e)l e_fr 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. STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by VjolAct vut.Q L . E. . ,'l.otit apLc On this ,i ,-i day of C_Arc)%A.X . [A\_ �� S kA � ,WFNDY S.MAYER . Notary Public ir4i�nd for the State of Iovya o Commission Number 729428 •A• My Commissi n Expires 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). F, - - ,...tiiiiif r(-)/ TS///-- Sig : re of 'i • - hief or designee Date YO ' ; 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. • 71‘...efa-t:.6e...e---pc.) �f / //iSignaturity Clerk or designee D to 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 CIerWTAXIDRIVBADGEAPPL92014amended DOC 09/2014 010WADOT SMARTER I SIMPLER 1 CUSTOMER DRIVEN ..lowa dot goy Office of Driver Services PO Box 9204 Des Moines,IA 50306-9204 Phone:515-244-9124 1800-532-1121 I Fax:515-239-1837 www.iowadot.gov.. Certified Abstract of Driving Record Inquiry Date: 10/3/2014 DL/ID#: 575AH0683 (IA) Customer#: 5915479 Name: Mohamed, Mohamed Class: D ID Status: None Babiker Elwasila Address: 2652 ROBERTS RD APT 1D Audit#: 7478316 DL Status: VAL Issue Date: 10/29/2013 CDL Status: None City/State: IOWA CITY,IA 522462740 Expiration Date: 11/19/2017 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 2652 ROBERTS RD APT 1D Restrictions: NONE Restriction None Date of Birth: 11/19/1983 Supplement: Mailing City/State: IOWA CITY,IA 522462740 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 01/08/2014 02/18/2014 Improper Registration Johnson ;IA Name: Mohamed, Mohamed Babiker Elwasila DL/ID: 575AH0683 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 dpi At**,••••,••./, % 10/3/2014 IOWA•.0 • $ 06;esotesik of Driver ces +h11� aBf *** IowlaeDepartment eof'Transportation o i 7� I FASS Name: Mohamed, Mohamed Babiker Elwasila DL/ID: 575AH0683 f'r1 -73 M -'� ry • State of Iowa `�` Division of Criminal Investigation 1'� 41- ' 215 E.7th Street ,:r, ",,,, "if ir Des Moines,Iowa 50319 4_� IOWA \ Phone: 515/725-6066 Fax: 515/725-6080 .,, . No•-,,tor_ Iowa Criminal History Record Check ',�/111,1461.1\-0.,.e " � Walk-In Request � ow Your name: 1.-106A/tied �I'ott allc�' r Address: 2652 Ror1eYtc a'cc *- t 1� City/State/Zip: ,1))tib ( '-i. jt'jt t rj. 52214-6 Fill in all shaded areas. Phone#: ?)q -4q 1 -2j Requesting an Iowa criminal history record check on: Last Name Apellido(mandatory) First Name Primer Nombre(mandatory) Middle Name Segundo Nombre(recommended) NIP U lla t„1Q4 t"-HO ila/Med Bahl ilek Date of Birth Fecha Nacimienlo(mandatory) Gender Genero(mandatory) Social Security Number(recommended) I f I 1 CI q 8.� TYMale n Female 170 i j_ 511 2 Waiver Signature Firma(I he request is on yourself,please sign. If the request is on someone else,write N/A.) igA13P✓Py:a .cibl ( 'C- N_ Results c DCIIISE ONLY 2,� r1 *n CA As of Q-�IJ-it- �-< I' a name and date of birth check revealed: � tc9 w [No record found c...) [' Record attached DCI# DCI initials 1SW f,3 Receipt Number of requests Z x $15.00 per last name=Total amount$ 30— Method of payment: cash money order check# MasterCard or NG (Last4digits) r Cardholder's name (l Ndnei yid {Mo l4 f4 So DCI initials JAJ Credit Card# Exp. Date DCI-83 (09/09/10; Revised 10/1/10; form reviewed 08/11/14)