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Home My WebLink About14-020 Authorization Number / 9 - - 1 (Office Use Only) `fit mom�III �Air � 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 First Middle IAADLG Last --17—Name 2. Mailing Address -3 Tri 1 f e� C. i(71 • 3. Telephone: Home 5 Other: 4. Prior experience in transportation of passengers: tib Q 4 S 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When (� o 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense (( Where When _ 7. Have you been convicted of any traffic offenses in the last five years? T e of offense Where When /KI - 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When I� c) t 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 that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number i d(� vctS . 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 @revisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date � _ STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by ft1U rt ,c��; ,1 �jc-�� , . On this a.b-tt l- day of H1H J t WENDY S.MAYER 729428 Notary Public in era for the State of rdwa ;•�` My Corn fission ExPres ******* *******************************************************************************************************!******************************* 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). 14444 T74,w h/i Signature of Polichief 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. Si natu're of CityClerk or designee Date 9 9 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 cierk/taxidrivhadgeapp201 0 doc 03/2013 vi,Jan, 27. 2014 11 : 17AM CDivr 'MIA of Criminal rInvestigation, NNo.�7698 PP. X1/5 , u . L% III. [VI , L, JII • • 44 ••L�w,,,,, STATE OF IOWA s�";" '`(a ��" r, i, Criminal History' RecoMal Check -47;;.:;,,...7a,,,, l`�{Law4I f Il Request Form ` . " • DCI Account Number: t/00 (Itappliceble) -- To: Iowa Division ofCrltnMai Investigation From: City of Iowa City Support Operations Bureau,1"h'lom• City Clerk's Office 215 E.7th Street 410 B.Washington Street bes Moines,Iowa 50319 (515)125-6066 Town City, IA 52240 (515)725-6o90 PaY • Rhone: 319-356-5041 - Fax: 319-356-5497 • I am requesting an Iowa Criminal History Record Check on: Last Name(mandatory) First Name(minatory) Middle Name(tee mntttdcd) `Je"-N\ I \ N d'-ti,"-A.al d t (.n /VI O ka,v`-/Nc-cil Date of Birth(mandatory) // � Gender(manderoy) Social Security Number(rocommcnd1) e f `I - 1 l�r-t- OiVIaIe DRcmalo CI'g 2- - .33 " q° 7-5 Waiverin/brinaliorf:without a signed waiver from the subject of the request,a complete criminal history record iuy not be releasable,per Code of Iowa,Chapter 692.2.For complete criminal history record information,as allowed by law,always obtain a waiver signature i)-ern the subject of the request. Waiver.ReThascrheilby give permission for tho above requesting official to conduct on wacriminal bigamy record chock with the Division ofcanting! investigation(DCI). Any alminel Wiry dale concerning mo that is maintained by IheDCI may Teased es allowed by low. WaivdrSlgnatura: tttagy t law Iowa Criminal Hi r .R cord Check Rest il0 jar)only) (o As of 1-7,1-I Li , a search of the provided name and date of birth revealed: C'` b1 r' rTl C7 tt cn� N) No Iowa Criminal History Record found with DCT rn n -a r-i Yt al:Y • o r 0 Iowa Criminal History Record attached,DCI# r- N DCI initials IV ve v�n . Received Time7Jan. 21. ))2014 2:50PM No, 1051 u 1� Iowa Department of Transportation •;� Office of Driver Services (Toll Free)800-532-1121 PO Box 9204,Des Moines,IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/21/2014 DL/ID#: 137880959 (IA) Customer#: 4102089 Name: Sallh, Nagmeldin Mohamed Class: D ID Status: None Address: 2548 INDIGO DR Audit#: 6175614 DL Status: VAL Issue Date: 08/01/2012 CDL Status: None City/State: IOWA CITY, IA 522406808 Expiration Date: 08/04/2017 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 2548 INDIGO DR Restrictions: NONE Restriction None Date of Birth: 8/4/1967 Supplement: Mailing City/State: IOWA CITY, IA 522406808 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 11/28/2010 07/26/2011 S92 Speed IN Name: Salah, Nagmeldin Mohamed DL/ID: 137680959 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: lt'cif p ha, 4'.. • 7/iCI 1/21/2014 cZ2) ,`p87 S&y Officowaeof Driver Depaartme Department Services Transportation Name: Salih, Nagmeldin Mohamed DL/ID: 137880959