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Home My WebLink About14-188 Authorization Number 14-- 1 (Office Use Only) ww®'cam APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made 410 East Washington Street between 8 a.m.to 3 p.m., Monday-Friday.) Iowa City, Iowa 52240-1826 (319) 56 5 (319) 356-5497 FAX First Middle Last 1. Name 54(Y)A f-I us,TM 14H 1 i 2. Mailing Address ) y LS- A 6e4/ aft-t! .I 7 3. Telephone: Home ')9 - 00 - 6a 2T Other: 11 4. Prior experience in transportation of passengers: Thr r r',,c 2-C( w- lc UJ C . 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? I\1 O 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? tti Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? \, C Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ti Gr 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) !\t L 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) clerWtaxidrivbadg 03/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 5-5-7A6 0 42_ 3 . 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 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 (7 t n, c> (/\ . . t u,t . . On this a'1 . day of ^,a'‘‘s� WENDY S.MAYER Notary Public i End for the State of a z Y,. GL .n3s,on N.,,,Le. 72 120 • `moi; • My Commission Expires p 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). x/27 A Signature laf F hief 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. 51/4, ' �l Signate of City Clerk or designee to Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/2" (width) and 5'/2" (height)and prominently displayed to all passengers. ******************************************************************************************************tie***************************************** Office Use Only Approved application DCI report State certified driving record Website update clerI taxidrivbadgeapp2014.doc 03/2014 Aug. 26. 2014 4: 17PM Div of Criminal InvestigationNo. 8122 P 1/1 nary...[ r. tori II .-renni VIIJ viain ‘,Sty ui suwa „It,• hu. JVJV Fr' Lit • -t� 40-Pw,� STATE ®1IOWA ciikic fir' � Criminal History Record Check „ r.j i � iI1 •� , `• ; 5 r — � Ropiest Form \�r\,` •Mb � Y .--7)n • DCI Account Number: iiCYj�l”r -- (if applicable) To: Iowa Division of Criminal Investigation From: City of Iowa City • Support Operations Bureau, 1rt Floor City Cleric's Office 215 B.7'h Street 410 E.Washington Street Des lvfolneg,Iowa 50319 (515)725-6066 Iowa City, IP 52240 (5I5)725-6080 Fax Phone: 319356-5041 Fax; 319356.5697 • I am requesting=Iowa Criminal.Ii'isto1 Record check on: Last Name (mandatory) A({N1 g•0 :Hirst Name(mandato/0 O r,4O I n_Middle Name(recommended) A•MMe D ofAn1 n M lerAFA Date of Birth (mandatory) Gender(mandatory) Social Security Number(recommended) G ^ (' I 9 7 2 dale ®Female 218— II- 1/ 92_0 . Waiver Information:Without n 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 walvor slanature from the subject of the request. • Waiver Release:r hereby gleepemdsslon forihe aboYc rcgUesting official to conduct an Iowa criminal history record check with the Division of Criminal rnvesllgetion(DCO. Any criminal history data concerningme[het is maird tined by the DM may Isereleased as allowed by raw. • • Waiver Signature: earta:�J L ) D AA344-4_ Iowa Criminal History Record Check Results . .(DC1manly) . Of �.. '�� , a search ofthe provided name and date of birth revealed: ,-,I ".) - As o kNo Iowa Criminal History Record found with DCT : ' -• ❑ Iowa Criminal History Record attached,DCI# . DCI initials JP- Received Time7Aug. 21. 1(2014 11 :40AM h. 7630 } luf s DOT vvvvW l vvadc t gov SMARTER ISIMPLER ICUSTO ER`DRIVEt _ _ Office of Driver Services PO Box 9204 l Des Moines,R50306-9204 Phone:515-244-9124 P 800-532-1121 [Fax:515-239-1837 wwaviowadot.gov Certified Abstract of Driving Record Inquiry Date: 8/19/2014 DL/ID#: 551AG0523 (IA) Customer#: 5878593 Name: Ahmed,Osama Mustafa Class: D ID Status: None Address: 1545 ABER AVE APT 7 Audit#: 6217221 DL Status: SUR Issue Date: 08/15/2012 CDL Status: None City/State: IOWA CITY,IA 522464707 Expiration Date: 05/01/2016 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 1545 ABER AVE APT 7 Restrictions: NONE Restriction None Date of Birth: 5/1/1972 Supplement: Mailing City/State: IOWA CITY,IA 522464707 Sex: M History Infformation CLEAR DRIVING RECORD Name: Ahmed, Osama Mustafa DL/ID: 551AG0523 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 o$;: ..4�' 8/19/2014 /' IOWA Si $ :D. O. T. es �. trr��"f'' B[YE6s' IowaDepartment of Driver eoflTrs ransportation • Name: Ahmed,Osama Mustafa DL/ID: 551AG0523