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Home My WebLink About18-109IDENTIFICATION NO. 9 j ° j 1 l 1 (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday— Friday) CITY OF IOWA CITY 410 East Washington Street Failure to complete the "required" information will result in denial of the application Iowa City, Iowa 52240-1826 (319)356-5040 - (319) 356-5497 FAX First Middle Last 1. Name(REQUIRED) 1.,1aq�Y �(�LA),1✓ 2. Address (REQUIRED) 3. Contact Information (REQUIRED) Email:ma.n.� Cell Phone: (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 647 }Z b. Taxicab Business Name (REQUIRED) _ � 6�� 5. Prior experience in transportation of passengers: 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Tvne of offense tnrt.e.e WAI�-- What happened to the charge? (Circle one) Convicted Dismissed eferre Suspended Plead Guilty 7. Have you been arrested / charged With any traffic offenses in the last five years? Type of offense What happened to the charge? (Circle one) Where N Ln Other — When Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? AJ a I 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) WE 04/2018 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 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). I hereby certify that I have issued to me by the Iowa Department of Transportation valid Driver's license number OS lQyd FrZ issued on expiring on I understand that lf I falsely answer any questions in this application, that this ap cetio may be denied. ag 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 authorization to be a taxicab driver 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 aMl otary Public) o_ Signature of Applicant Date G r, tv 0� _ -•o ly_Jj !Nf!!flNlNlNf 1lNflf 1flNlNN11NN4NN1f flN1NM'Yf1tIflNYlt1N111f!11f11! k}f!!f f 11f1411NNNNNNi flNNtllMtY}ktyff111ffyFlf!!lfllf STATE OF IOWA ) COUNTY OF JOHNSON ) s and sworn to before me by MocQcLs I' r- Y� k�cawe a.N I on this off) day of and for the Stat'$ of I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of D er' icense Signal" Police Chief or designee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. of City Office Use Only Approved application DCI report State certified driving record Website update Date aenrtnxiowvenocenraLe201ean�,eea.Doc 04/2018 11wNov, •14. 2018:i11:31AMcab DCI IOWA 0:431933800- 1070 P, 1/31002 I am reouestina an Iowa Criminal iilamrvitennrei C!hnnle- nn! Last Name (mantiamry) I Mrst NRme mandmory) • Middle Neime roocmmepded STATE OF TONNA Criminal History Record Check. Request Form •'.Sorial•Seenri Number meommmdcd) /�'� l°�G3 o ` r0-^�� DCI Account Number: 9967-F (if applicable) v To: Iowa bivhlon of criminal investigation From: 'Yellow Cab of Iowa City Support Operations Bureau, 1". Poor R.O. Box 428 215 E. 7fe Street t - 1 bet Xolnet, Ioyva $0319 Iowa City, IA. 52244 (315) 725-6066 } (515)725-6080 Ax ' (319) 338-9777 Phone, Fax: (319) 339-7302 I am reouestina an Iowa Criminal iilamrvitennrei C!hnnle- nn! Last Name (mantiamry) I Mrst NRme mandmory) • Middle Neime roocmmepded Date of Birth (mandato ',(render mandato •'.Sorial•Seenri Number meommmdcd) /�'� l°�G3 ►; [Male ❑lrernale ` r0-^�� A Waiver Information: Without a s'iped f alver from the subject of the request, a complgte criminal history record spay not '156 roloaseble, per Code of Iowa, Chapter 692.2. For co_ mplete criminal history -record Information, ag allowed bylaw, always obtain a waiver signature from thastib eo.4f tho re lues+: r, Waiver Beleave: i hereby Give pcnalssion for thcaboveradaesdne ot0o111 to oonduel An Iowa odmind blamty record eheek with the Dlvlslon of Criminal lnvicetigatidn (DCI). Any criminal httmry data eonctanidg me that is maintained by the Del may be releuad of alloweq by law. Waiver Signatures t - 1 w , Iowa Crimi3lal Hisiory Record Check ResuIi?s (r)CT era only) As of a searclLof the provided name and date of.birth revealV;; ❑ No Iowa Crlminal History Rccord found with DCI .�( Iowa Criminal Hisfory Il`l'Cord attacted,'DCl 0 • ,� DCI Initials DCI -77 (08/25/10) Received Time Nov. 7. 2018 2:46PM No, 0363 ,Nov..14.2016 11:31AM DCI IOWA ' IOWA CRIMINAL HISTORY DCI 00989990 CHARGE NO- 02 IA STATUTE NON CONVICTION PAGE 1 OF 1 DATE PRINTED - COURT DISPOSITION 2018/11/14 DCI:00989990 AGENCY: IA05201511 JOHNSON CO DIST COURT NAME: MOHAMEDALI,MODASIR KHIL IA STATUTE: IA708.2(6) DOB SER RAC HOT WGT EYE HAIR SKN POE 19630928 M B 506 199 BRO ELK DRK YY ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 20130917 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 02 IA STATUTE IA708.2(6) ASSAULT TRK#: IAOOHL702 COURT DISPOSITION AGENCY: IA05201511 JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA708.2(6) ASSAULT COURT CASE ID: 06521 AGCR103031 CHARGE CLASS: NON CONVICTION TRK#: IAOOHL702 DISP EFF DAT SENTENCE $100 20140310 FINE DEFERRED JUDGEMENT $100 CIVIL PENALTY 20141118 PROBATION lY 2014111B 20141119 DISCHARGED FROM DEFERRED JUDGEMENT No.1010 P. 2/3 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 HE RELEASED TO NON -LAW ENFORCEMENT AGENCIES IAY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD I9 BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY- DIVISION OF CRIMINAL INVESTIGATION -Nov. -14.2018 11:31 AM DCI IOWA . No. 1070 P. 3/3 DISCLAIMER . This response can only include pugilo'dlrlminal history date. Underiowa few, most Juvenile records ere confldon(laL Confldanffal Jpvenlla court records,.if any, cannot be included In th/s response,rA slgned;releasa authdr&aflon Is not riulflclent to dbtain this lnformatidri from the DIVlslon'of Criminal Investlgaflon, In order to request thq release of confldentlaiJuVenlle records; If,any, an appilcatlon must hellled,pursuant to Iowa Code. sac(lon 232,1#08), Additionally, orlminal hlatoiy data cloncerning convipllons for curtain Juvenife sox offenses, can be found on the Iowa Sex pffeader.Reglsiry: ft i/ w o o e c , Ilowovar, even (!lough some Informaflon !s avallob(e on ih/s site, the acfua/:repo s for)uvenlles nfayallll be confldantlAl and any cgnfldential Juvenile records cannot bo prov/ded With'thla record, !n order fo request the release of + aonf/dantlal JuvenIto.repords, lfany, an appllFatlon mustbe f/lod'pursuant to Iowa Code secflan 232,147(18), N C4010WADOT ov SMARTER I SIMPLER I CUSTOMER DRIVEIJ www.iowadot.gov & IdsniifiwGon Services PO Box 92041 Des Moines. IA 50306.9244 Pbarle: 515.244.91241 Fax: 515.239.11837 Inquiry 11/7/2018 Date: Customer #: 1142265 Certified Abstract of Driving Record DL/ID #: 082AA0058 (IA) CDL Permit Class: None Class: D Name: Mohamedali, Modasir Audit #: 8489835 Khlilil Address: 647 Emerald St Apt C14 Issue Date: 09/30/2014 Expiration 09/28/2022 Date: City/State: Iowa City, IA 522463023 Endorsements: Chauffeur 3 Mailing 647 Emerald St Apt C14 Restrictions: NONE Address: Restriction None Mailing Iowa City, IA 522463023 Supplement: City/State: Date of 9/28/1963 Birth: Sex: M History Information CLEAR DRIVING RECORD Name: Mohamedali, Modasir Khlilil DL/ID: 082AA0058 (IA) CDL Permit Issue Date: CDL Permit Expiration Date: CDL Permit Endorsements: CDL Permit Restrictions: ID Status: DL Status: CDL Status: CDL Permit Status: CDL Cert Status: CDL Med Status: None None None None None VAL None ELG None None Pursuant to Iowa Code §321.10, I, Darcy Doty, Driver & Identification Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by Driver & Identification 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 dater Name: Mohamedali, Modasir Khlilil DL/ID: 082AA0058 (IA) 11/7/2018 d92124�� dem Driver & Identification Services Iowa Department of Transportation