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Home My WebLink About14-212 } Authorization Number t'Li-02 Jc OA. _ 1 (Office Use Only) gIII N4- AO= 111�� APPLICATION FOR TAXI/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 Fir t iddlL s4 1. Name (REQUIRED) ) 17)�I-mP �S 7>�7� �P l�i e)41G1--n 2. Mailing Address (REQUIRED) , O2 i -h ?/ ( Rd ,G !/I 3. Contact Information (REQUIRED) Email:�/.l?) r)-7�3 Z D ,ejYyajb� Cell Phone:Mi?37 4. Prior experience in transportation of passengers: Y'"sL r 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? f V b 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? W Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? T e of offense Where When pe? \ n f ? 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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) YC) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CE.; IFIF,D DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEVQW -'q You must apply for an individual Department of Criminal Investigation Report(form availaTopoi equea.,. (OVER FOR REQUIRED SIGNATURE AND NOTARY) lr , 09/2014 I be ile_re4y certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license nr 71.,er 1 6.3)/-1)-}i ---? .,e . I understand that if I falsely answer any questions in this application, that this application may be denied. 1 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) Q I Signature of Applicant • - -- - - Date e`�/) /)6)�h 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 'CAA c,1 ka 0.,�s�,Cv ik Sul.i-e.4_1\,c , On this ) �4-�, day of � aWENDY S.MAYER Notary Public it nd for the State of w•4a f z `: Commly or N,,.,,h.,79ga9R rY My Commission Expires low , .1:252'1 ***************.**************************.************************************.***************************************************************. 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). P------------- q_71 cl //7 Si na re olice Chief or designee nee Date 9 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. Signature of City Clerk or designee Die Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/2" (width)and 5 '/z" (height) and prominently displayed to all passengers. *************************************************************************************.********************************************************** Office Use Only Approved application DCI report State certified driving record Website update Clerk/mAXIDRIVBADGEAPPL92014amended.DOC 09/2014 Sep, 17. 2014 10 : 01AM Div of Criminal Investigation AN o. 9900 P. 2 m 'IJV. IL. L V I' Y. L V I III v i t t' V I C I M1 1/4, I t y U I Iowa vitl IVU. )LVL r. L LtJ p „ STATE OF.IO A L ; ' , ` Creiraa �aHistory Recon Check . ; t', ,fi t. . . •f r . � , 1.egitestt Form ,.%u=7 DCI Account Number: 21-661 Z2 "r of applicable) To: Iowa Division of Criminal Invrestigation From: City of Iowa City • Support Operations Bureau,1S`Floor City Cleric's Office 215 E.11h Street 410 E.Washington Street Des Moines,Iowa 50319 (515)725-6066 Iowa City, IA 52240 (515)125-6080 Fax Phone: 319.356-5041 - have: 319-356-5497 I ain requesting an Iowa Criminal History Record check on: Last Name (ivandelory) ff+irst Name(mandatory) Middle Name(reconiniendedj _ Sja biefron ti,h,p4ed Date of Birth pnanaalo j Gender nlandauo Social Securi Number recommended b\ ) 31) 61 77 Ef ale Orem ale b 1 33 33Z Waiver If formatiota;Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 692.2.For complete criminal history record Information,as allowed by law,always obtain a waiver signature from.the subject of the request. . • Waiver Release:I hereby give permission for the above requesting official to conduct an Iowa criminal history record check with►heDivisfon ofCriminel Investigation(DCI). Any criminal history data concerning me that is maintained by tlmn DCI may bo released as allowed by law. Waiver Signature, - . owcr imiraaX Jtxsto ecRecord Check Results 52 Ails As of 9- 1-7-q , a search of the provided name and date of birth revealed: :-t c- a. :'' <:, ;=;: _ - 0 No Iowa Caitminal History Record found with DCI " ` `?. 1 . LI Iowa Criminal History Record attached,DC1 DCT initials ;)laralUA'I Timm-CGn 11 —161d-- d. 17PM—Nn. Il 7 I Li WM DOT `... www,i owadot.gov SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Driver Services PO Box 9204 •Des Moines,IA 503066-9204 Phone:515-244-91241.500-53271121 I Fax:515-239-1.837 www.iowadot_gov Certified Abstract of Driving Record Inquiry Date: 9/17/2014 DL/ID#: 651AH5368 (IA) Customer#: 6042906 Name: Sulieman, Mohamed Class: D ID Status: None Muslim Address: 2602 BARTELT RD APT Audit#: 7544794 DL Status: VAL 2C Issue Date: 11/20/2013 CDL Status: None City/State: IOWA CITY, IA Expiration 07/23/2018 CDL Cert None 522462727 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 2602 BARTELT RD APT Restrictions: Corrective Lenses Restriction None 2C Date of Birth: 7/23/1977 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522462727 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 10/05/2013 10/07/2013 S92 Speed Johnson IA Name: Sulieman, Mohamed Muslim DL/ID: 651AH5368 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: ^o....,,,,,� , 9/17/2014 p:' IOWA -s1 ,S%D. O. T. itp rri 11+V • DBIVE,,,,,, Iowa Department o Driver Ser iTransportation —In; — n LO Tom., 1›. I Name: Sulieman, Mohamed Muslim DL/ID: 651AH5368 — r �