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Home My WebLink About14-031 . Authorization Number y r I — 1 (Office Use Only) "` ww®"XX. -rti.as._ 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 Cit .law.a_ 52240-1 8226 031356-5040 tai a-lly- (319) 356-5497 FAX . First Middle Last ` 1. Name 3�\��eah O �ti' b1��1111 �� b Y'/�1C1\Y1 2. Mailing Address gib( b, 3. Telephone: Home c3\c\ ) $j3 4 y-3 Other: \R ) 333 2\ 1 4. Prior experience in transportation of passengers: y ea(S 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? t i v 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? f7) Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? �1 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 03/2013 I hereby certify at I have, issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 9 ` . 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 2 ************************************************************************************************************************************************ STATE OF IOWA COUNTY OF JOHNSON ) C r t Subscri Ded and sworn to before me by ....)Co toy 1 C1 J _ —I—-I-b r& 111►'lit �I do is 124^ day of TUTrI E I (. -t �tnt s KEI.UE K. 221819 ` 1 ;cn ..mower Nu Notary Public in and for the State of Iowa VAr ************************************************************************************************************************************************ 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). Sig ture of P.li.e- .r 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. 4.2 Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/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 clerk/taxidrivbadgeapp2010 doc 03/2013 Iowa Department of Transportation . . Office of Driver Services (roll Free)800-532-1121 ii 41411. PO Box 9204,Des Moines,IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 2/18/2014 DL/ID It: 422AF7170(IA) Customer It; 5609235 Name: Ibrahim Mohamed,Saifaldeln 0 Class: D ID Status: None Address: 2401 BARTELT RD APT 2C Audit rt: 5748482 DL Status: VAL Issue Date: 01/19/2012 CDL Status: None City/State: IOWA CITY,IA 522462701 Expiration Date: 05/13/2015 CDL Cert Status: None Endorsements: 2 CDL Med Status: None Mailing Address: 2401 BARTELT RD APT 2C Restrictions: NONE Restriction None Date of Birth: 5/13/1960 Supplement: Mailing City/State: IOWA CITY,IA 522462701 Sex:. N History Information Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 06/12/2013 744204 ate Name:Ibrahim Mohamed,Saifaldeln 0 DL/ID:422AF7170 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: 1y o0�U111If 0j`jhi 'ic :r '�: .W. 2/18/2014 fsa4nliittO44h s Iowaaof river Services Department of Transportation Name:Ibrahim Mohamed,Saifaldeln 0 DL/ID:422AF7170 Feb. 14. 2014 1 :38PM Div of Criminal Investigation No. 2954 P 2/10 • '1 rv. ivy ev ,n IL•LVIul VI , y YICII vary VI tuna wiry IVU. 4JU4 f. L STATEOF IOWA /r�1 / /ISM:" Criminal HistoryRecS Check t t :::o \` Request Form DCIAccountNuinher: 40O0 (Itepplleeblo) • To: town Division of Criminal Investigation From: City of Iowa City Support Operations Bureau,la Floor City Clerk's Office 216E.7'h Street 410 R Washington Street beg)Moines,Iowa 50319 (515)7254066 Iowa City, TA 52240 (515)725-6000 Fax Phone: 319-356-5041 • Fax, 319-356-5497 Yam requesting an Iowa Criminal Iiistoty Record Check on; Last Name(mandatory) First Name(mandatory) • Middle Name(reeoamlended) 6Yqh i wiYvl oke h1 cd c,a I MY) • 3 Y)1 eY Date of Birth(mtleandator)) • Gender(manow) Social SecurityNumber(recommended) a 1151 \a‘80 Malo ®Female k 6c- s 6 - 4-366 WaiverLgfbrmation: Without a signed waiver from thesubleetofthe request,a cothpleie criminal history record may not he reieasnble,par Coda of Iowa,chapter 692,2,For comnie(e criminal history record information,as allowed by law,always obtain a waiver signature from the subject of the request. Waiver Releyrse:I hereby ghee permission for ilia above requesting onletei to conduct en Iowa oriminl hratoryrecayd chcckwith Mu Division of Criminal Inveetigatian(DCI). Myalmfnt(hisiorydelaeoneunfngmorhaLIsm lsiaedbyrhsDCimaybareleaeedatallowedbylaw Waiver Signature: {��"- ' • • ]I Criminal Historygcord Check ce 1 (DC;use sniy) As of �. N,\1 , a search of the provided name and date of birth revealed: r.. No Iowa Criminal Ristory Record found with DCI • • Iowa Criminal History Record attached,DCT# r• DCI initials t . Received,1imeJ7ieb 10io2014 12: 19PM—No: 2582