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Home My WebLink About14-034 Authorization Number I• f _ 1 (Office Use Only) ai;g11140,47ithiTtl ��•. +. y ®mall APPLICATION FOR TAXI 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 FirstMi�d Ie Last 1. Name \\Q-t ki v �V\\AA9--cA Auk SS 1v\p\i\A vvd 2. Mailing Address -2_.`-k0 \-1-- ti'Cke .\1- V..0 , Q \ o3`'� (--)Ok`I' 2L'-1'o 3. Telephone: Home t\`\ ) `.10 0 11.3 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? Nic) 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? NI V Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When S Q e-402'A1 ( \ 1\ I (S l 1Po Q( \'LQ\ v\o\ck-k- O S ( 1 I ( `2-o \ Z 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? k/ 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) )0 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) clerkflaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license nuini)er C Qom- . 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 f J - Date Z 1 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by t-)ra-t, A-. f4 . itAe . On this I --t 4 day of �c�srUKF� 1 1:9.141 WFNDY S MAYER Notary Public in rid forr the� wae otilo.t Commission Number 729428 ,,.t • My Commission 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). S. nafure4 Police Chief 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. (),/.2, ,L Signature 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 1/2" (height) and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update deNtaxidrivbadgeapp2010.doc 03/2013 09.70;C61NWeµpgecs[ jrOav9 : :1 x410/ 0 3Z8Oob Se s :5i 3OZG-ow is 96 g $6;(d4"% bl 173;(,LYO bM01 ;it 18b8 eon ' �Ng=SSONtO31,va _t e..bY _ 3Sr 03W7NOW _.� �✓'� a -44180 ibY983WW00..._. \Irn02 • • X22 Page 1 of 1 Iowa Department of Transportation i Office of Driver Services (Toll Free)800-532-1121 PO Box 9204,Des Moines, IA 50306-9204 515-244-9124 414111. FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 2/14/2014 DL/ID#: 570AG6289 (IA) Customer#: 5911203 Name: Mohamed, Hatim Class: A ID Status: None Ahmed Husseen Address: 2402 BARTELT RD APT Audit#: 5988411 DL Status: VAL 1B Issue Date: 05/17/2012 CDL Status: VAL City/State: IOWA CITY, IA Expiration 01/01/2016 CDL Cert Non-Excepted 522462703 Date: Status: Intrastate Endorsements: NONE CDL Med None Status: Mailing Address: 2402 BARTELT RD APT Restrictions: NONE Restriction None 1B Date of Birth: 1/1/1973 Supplement: Mailing City/State: IOWA CITY,IA Sex: M 522462703 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 11/15/2009 _ _ __ 03/12/2010 _ S94 Speed CA 05/11/2012 05/17/2012 F04 Seat Belt Violation Johnson IA Name: Mohamed, Hatim Ahmed Husseen DL/ID: 570AG6289 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: "ria ..tECR t% 2/14/2014 (CPu) a _ ^'�� rvices �'N "_ Iowa Department Office of Driver eof Transportation Name: Mohamed, Hatim Ahmed Husseen DL/ID: 570AG6289 2/14/2014 Feb. 14. 20141 1;36PM4 Div of Criminal Investigationy No. 2954 P. 1/10 • • anr,4oati. ,, STATE-!L OF IOWA ;, 1,f,, t1, (. _sL 4a, Crinnnn>jSS]H[notory Reco>rdl Cheek , y II lo�ln :^�`, IRet0uaS iF rnt P& `, :,,,: obi• , '^`r: • DCI Account Number; Nbt?•F (If applicable) To i Iowa Division of Criminal Investigation Prom: City of Iowa City Support Operations Bureau,lie Moor City Clerk's Office USE.7'i'Street 410&Washington Street Des Moines,Iowa 50M9 (515)725-6066 Iowa City, IA 51240 (515)725-6080 Fax Phouei 319456-5041 VAX( 319-356-5497 - I am requesting an Iowa Criminal History Record Check on: Last Name(mandatory) First Name(mandatory) Middle Name(remm coended) t \ 0 VOL wt-eil 1A a\A- t vv) CAti inn e--o'1lk v\S S eel Date of Birth(mandaroty) Gender(mondatorl) Social Security Number(rccommended) 1 I ' / 1 1 1 i ale OFemale 1o0 17.- r Lt 1 tt t WariverInfohnallon:Waltman signed we illOr from therubject of the request,a coinpleta criminal history record may hot be releasable,per Code of rows,Chapter 692,2.For potnpiete criminal history record information,as allowed by law,always obtain a waiver signature horn the subject of tho request. Waiver Release;Iheteby give purmission for rho above requesting official fo conduct an Iowa criminal history record checkwith the Division oftrIndnal • iarestigalion(DCI). My erbinal history dais meaning me that l dntalurd by 11w Denny bercicased al allowed bylaw. WaIVerS`lgfuttrtre; • Iowa Criminal][i[istory i"ecord Check Results (Dfanaa only) As of a't 3111 , a search of the provided name and date of birth revealed: ; ` • pNo Iowa Criminal Risley Record found with DCI • . , fl Iowa Criminal History Record attached,/)C14 . i" • I)Crinitials Received Time;,Feb. 10..72014— 1 :01PM—No. 2589'