HomeMy WebLinkAbout14-035 Authorization Number / r 3
TA r 1 (Office Use Only)
-6E
CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER
(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
FirstMiddle Las
1. Name �cx_vo. 4-ckk I t r-c\Me-A
2. Mailing Address POO. b x 3 4)- C 5 224 1\
3. Telephone: Home 3 ) Cf - 3 - 3423 Other: 3n q 36D I Q
4. Prior experience in transportation of passengers: 3 /e(cr
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? N- 6
Type of offense Where When
6. Have you peen convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? Ni0
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? NO
Type of offense Where When
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)
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CER_DElED-
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 03/2013
4L_Ilereby certify that I have issued y, me by the Iowa Department of Transportation a valid Chauffeur's license number
b0-YcV& 1`+'l�)l/u-.>ca Nr�), . 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) l
Signature of Applicant • \ Date q— Ia— l 3
r_J
STATE OF IOWA )
COUNTY OF JOHNSON )
S cribed and svyorn to before rrte, by RI nala f01° ►�61AQ-G�. On this } 6 --- day of
I -t 4v )e 1T I 20 I --- --J
l- { ( r---P /r � 7`(j--'
"Ai,p,, KELLIE K.TUTTLE Notary Public in and for the State of Iowa
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***************************************************,7****** ****d*******************************************************************************
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).
Signa re of P 1 Chief or designee Date
- _) P/ l t. t�u�- �Co � /1 //ems%,
YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORISATION IS RECEIVED FROM THE CITY .
CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. L- ,2.-,--G
a,, 2� 1'C • 1f r_�' � /�
ign ure of City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width) and 5 '/2"
(height) and prominently displayed to all passengers.
************************************************************************************************************************************************
Office Use Only
Approved application
DCI report
State certified driving record
Website update
derkttaxidrivbadgeapp2070.doc 03/2013
Sep. 9. 2013 4: 34PM Div of Criminal Investigation No. 5384 P. 2/3
Sep. 3: 2013 4:31PM City Clerk – City of Iowa City No. 3833 P. 2
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Received Time Seo. 3. 9011 4:11PM No. 5949 ,m
Sep. 9. 2013 4: 34PM Div of Criminal Investigation No. 5384 P. 3/3
IOWA CRIMINAL HISTORY DCI 00954934
MISDEMEANOR CONVICTIONS ONLY• PAGE l OF 1
DATE PRINTED-
2013/09/09
DCI,00954934
NAME: MOHAMMED,BARAKAT FAGEERY AHMED
DOB SEX RAC HOT WGT EYE HAIR SRN POB
19710610 • M B 509 150 BRO BLK DRK YY
ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y
CCH RECORD ***
01 ARRESTED 20120423
AGENCY: IA0520200 IOWA CITY PD
CHARGE NO- 01 IA STATUTE IA708.2A(2) (A)
DOMESTIC ABUSE ASSAULT
TRK): 1A00E5U01
COURT DISPOSITION
AGENCY: IA052015J JOHNSON CO DIST COURT
COUNT NO- 01 IA STATUTE IA700,2A(2) (A)
DOMESTIC ABUSE ASSAULT
COURT CASE ID: 06521 SMSM099571
CHARGE CLASS: MISDEMEANOR CONVICTION
TRK#: 1A0 OE5U01
SENTENCE DISP EFF DAT
•
DEFERRED JUDGEMENT $65 CIVIL PENALTY 20120730
PROBATION lY 20120730
COMMUNITY SERVICE 30H 20120730
FINE $500 20121210
REVOKED 20121210
AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD
MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF
IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON-LAW
ENFORCEMENT AGENCIES BY THE DCI.
IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS •
BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD
COVERS THE SUBJECT OF YOUR INQUIRY. •
DIVISION OF CRIMINAL INVESTIGATION
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(83 111
Iowa Department of Transportation
tif�ce d Omer Services (Talk Fri�e)800.532-1121
PO Box 9204,Des Manes,to 50306-9204 515-2449124
FAX:515.239-1837
Certified Abstract of Driving Record
Inquiry Date: 9/3/2013 DL/ID#: 435AF8256(IA) Customer#: 5626613
Name: Mohammed, Class: D ID Status: None
Barakat Fageery
Address: 2401 HIGHWAY 6 E Audit#: 6060611 DL Status: VAL
APT 4813
Issue Date: 06/19/2012 CDL Status: None
City/State: IOWA CITY,IA Expiration Date: 06/10/2015 CDL Cert Status: None
522406795
Endorsements: 3 CDL Med Status: None
Mailing Address: PO BOX 342 Restrictions: NONE Restriction None
Supplement:
Date of Birth: 6/10/1971
Mailing IOWA CITY, IA Sex: M
City/State: 522440342
History Information
Convictions
Citation Date Conviction Date ACD Explanation County JUR
08/24/2009 10/21/2009 M17 Fail to Obey Traffic VA
Sign/Signal
07/09/2011 08/10/2011 F04 Seat Belt Violation Johnson IA
11/20/2011 01/02/2012 F04 Seat Belt Violation Johnson IA
12/31/2011 05/01/2012 592 Speed Johnson IA
07/10/2012 07/25/2012 S92 Speed (10 mph& Johnson IA
under in 35-55 mph
zone)
Name: Mohammed, Barakat Fageery DL/ID:435AF8256
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: