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Home My WebLink About14-175 Authorization Number P-1 -" 17 5- (Office Use Only) 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) 356-5040 (319) 356-5497 FAX First MiddleLast - 1. Name i-1 A,J E vm as WI I Cr\r` Sk 2. Mailing Address 2504 A 1r, %Jet C.t�1 lc>w C' 3. Telephone: Home 3 1c1 (100 cl 3 7 Lf Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? WO 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? kJr7 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years?J�; 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? Af 0 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) 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) clerk/taxidrivbadg 03/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number Li i Cj 4(y 77 5� . 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 Applicantt).---t-6-4--47- s- -4--f Date o2)/`62// 07,01 ti 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 byu.t- ( G- G (--rr IA. 1 . On this a.l ,.4- day of /3(-1...i43U \f n-0 i ti. I Q ' - J otary Public i, and for the State .'Iowa .)-alar wP/vpy g.ppertiR Z. ,,, 1• Commission Number '29428 iowe. MY Commiss. E pires 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). -5/2-/,/{ ,4 '�fy Signature ofPo hief or designee 13/,tae 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. Signatu e of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width)and 51/2" (height)and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update clerWtaxidrivbadgeapp2D14.doc 03/2014 SMARTER I SIMPLER I CUSTOMER DRIVEN 1N1 VVV.Io VaCIOt.gOV Office of Driver Services PO Box 9204 I Des Moines,LA 50306-9204 Phone:515-244-9124 1800-532-1121 I Fax:515-239-1837 ww,v.iowadoLgov Certified Abstract of Driving Record Inquiry Date: 8/21/2014 DL/ID#: 549AG7752 (IA) Customer#: 5876365 Name: Eigorashi,Amar Class: D ID Status: None Elmustafa Address: 2504 BARTELT RD APT Audit#: 6719060 DL Status: VAL 1A Issue Date: 02/22/2013 CDL Status: None City/State: IOWA CITY, IA Expiration 03/26/2016 CDL Cert None 522462714 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 2504 BARTELT RD APT Restrictions: Corrective Lenses Restriction None 1A Date of Birth: 3/26/1984 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522462714 History Information CLEAR DRIVING RECORD Name: Elgorashi,Amar Elmustafa DL/ID: 549AG7752 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: .. .. pgyp ... ...... p�!/�4� 8/21/2014 ,j Ftr�: IOW" •:2�i �� i/�4 ;tri I, Nor ORIVEAS„= Iowa Department of Driver rtmr[Services orta[lon Name: Eigorashi,Amar Elmustafa DL/ID: 549AG7752 IAug. 21. 2014 2:22PM (Div of Criminal Investigation NN0. (j027 PP. LI/1 -,;:al OF F[/moST� = ®FH IOWA J . l!'me ` `\ y.. 0r Ll ', Criminal llistorry Record Check ;' I :) (C.tlowf i'i , k. —,r.;' Request Form %CC:_ ''� Fr i o>li) • DCI Account Number; V or:52,P (If applicable) To: Iowa,Division of Criminal Investigation From: City of Iowa City Support Operations Bureau,la Floor City Clerics Office 21S E.71a Street 910 E.Washington Sired ))es Mohre4,Iowa S0319 • . (S15)7254066 Iowa City, IA 52240 (515)725.6080 Fax . Phone: 319.3564041 Fax; 3194564497 I am requesting an Iowa Criminal RlstolyRecord Check on: • Last Name(mandatoy _ flretName(nundatoy) Middle Name(recamended) EItOlr«.sVI. ; Aw.akr G L mus r.h.. Date of Birth(mendelory))L Gender(mandatory) Social Security Number(reoonlmended) _ O3/2G/iy�j 7 Skate Oren-tale 6,2-P4- 3909 Waiver Ii{/orinallon: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.I:or complete criminal history record Information,as allowed by law,always obtain a waiver signature from the subject of the request. Waiver Invellgetroa(DCO. Any criminal ldstocy dela contenting Pie hitt is me(nlalned by lila DC may be released as allowedhy law. Waiver Signature: --u--A-------- iglu-, M�� • Iowa Criminal llistory Record Check Results (Dail;only) As of lc' )'1'l't , a search of the provided name and date of birth revealed: cis . at• I „ `�'�\ No Iowa Criminal History Record found with DCT . . CI Iowa Criminal History Record attached,�DCI# • DClinitials tt�I , Received Time7'Aug, 15.1(2014 2:40PM No, 7541 •