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Home My WebLink About14-016 • Authorization Number 19 - f I„), � r 1 (Office Use Only) -1:4-1Z:411 _14 "It alle Mal Air 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 r First pi() AC4y/6.d Middle a pac5se.1,0 Last rnAs �r / 1. Name f 2. Mailing Address 2 b 7- /1- Ur.S $T v;II e , -TA S Z .4 I 3. Telephone: Home S/5 - LtS/ — 1 73 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? /V0 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? r _. Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? y'" Type of offense Where When 5 Ca/ 8'e/t T,cf,_�G C, - 12- 8. z8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? yew 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) (ti 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) clerMaxidrivbadg 03/2013 f • I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number . 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 3 1 L/ STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by ki`,v ct k . �v� -Q � . On this ; rd) day of 2'011 WENDY S.MAYER Notary Public in a d or the State of(to(�lowa (4040,:'. Commission Number 729428 • M 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). 21 et/ o2 Sign ure of P. c� 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. 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 clerkftaxdrivbadgeapp2010.doe 03/2013 .. - OriN Iowa Department of Transportation c83 Once all WW1 Santulli (Toll Free)800532.1121 PO baa 9204,Des Moines,IA 503069204 515-244-'9124 11111110 FNC 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/14/2014 DL/ID #: 713XX1907 (IA) Customer#: 1524059 Name: Mustafa, Mohamed Class: D ID Status: None Elhussein Address: 807 HUGHES ST Audit#: 6273738 DL Status: VAL Issue Date: 09/05/2012 CDL Status: None City/State: CORALVILLE, IA Expiration Date: 10/01/2017 CDL Cert Status: None 522412143 Endorsements: 3 CDL Med Status: None Mailing Address: 807 HUGHES ST Restrictions: Corrective Lenses Restriction None Supplement: Date of Birth: 10/1/1983 Mailing CORALVILLE, IA Sex: M City/State: 522412143 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 06/17/2012 07/16/2012 F04 Seat Belt Violation Johnson IA Name: Mustafa, Mohamed Elhussein DL/ID: 713XX1907 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: —r-1 '�'hl 1/14/2014 :' IOWA:' sk D. O. T..; evergeptemAcedigropip 14 qtu Office of Driver Services Iowa Department of Transporation Name: Mustafa, Mohamed Elhussein DL/ID: 713XX1907 Jan. 22. 2014 3:58PM Div of Criminal Investigation No. 7332 P. 4 . uuu. � e cull J. LVI 'I City VICIn - t,ity aI IUWd bit), No. 4L74 P. L • • OF IOWAN;1_,.1.11 ft` 4{t j STATE , F/ t11Criminal i:1istory Record Check Request orm(,J'lawn ! C'' ' -� DCIAcoountNumber: 4.6 02--Vz (ifspplkable) To: Iowa Division of Criminal Investigation From; City of Iowa City Support Operations Bureaux, 1't Floor ' City Clerk's Office 215 B,7n'Street 410 F.Washington Street Des Moines,Iowa 50319 • (515)725-6066 Iowa City, IA 52240 (515)725-6080 Fax Phone: 319.356 5041 Fax: 319.3565497 T VY; • I ain requesting an Iowa Criminal History Record Check on: Last Name (mildewy) . nil tNal/10(mandatory) Middle Name trewmmcaded) Date of Birth(mandatory) Gender(mandatary) Social Security Number(recommended) Jo V 0 - 8'3 OMale flfemale `k 2 di -3 S o 3 WaiverInformal/ow Without a signed waiver(rain the subject of the request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 692.2.Felt complete criminal history record Information,as allowed bylaw,always obtain a waiver signature from the subject of the request. Walter Release:I herebyglve permission for she above requesting of ieial to conduct an Iowa criminal history record check with rhoDivision of eriminel investigation(DCI). Any criminal hlefory dela concerning me that le maintained. a CI may bereleese4as allowed by law, Waiver Signature: . Iowa CriminalJjistory Record Check Results (DClusoonly) U r As of I-U.( 1 , a search of the provided name and data of birth revealed: - c- yn ('t i 7---- Li Co — :74 No Iowa Criminal History Record found with DCI •• .c-) `t ;0 Q r w s O2 71 — 0 El Iowa Criminal History Record attached,DCI it D DCI initials_ race ived Tiree7Jan, 17. D)2014 3:20PM No. 0949