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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(3 19) 356-5497 FAX
1. Namel,REr)UA4d'I',D)
(aIrl e Iia e O' My)
APPI 11CA111ON FORTAXICAB AXICAB N IM 6I C,4RiZ ED P EDICAB VE -11-11101 E DRIVER
(Police II)epartuaneant review imoaust be I rade between 8 a.nin. to S p.m, Monday • F'dday)
h%9UllI� Ifi���Jl�i�f (� /ii;, if �l/lI'^.�l llllfi/N/I/IL II ......... ......f 11„i,fl>>Jlr �fi///r� 1JJ dl�i lil„`71"l
wo
?. Address GFIE UUl REDl �� �r .. OR.' W" t rtr(1�1 .I ^.. e )
3. Contact Information kPIE 1 JIRI Email: K ) U w .r,r alll I n
Vl v,ri'I'Iy aorti7'u ia1;ini via annal)
(� r ) ��✓
fia. Chauffeurs cense
ro j u .. .. .._ ... ... ......
b. Taxicab Business Namel(RI: rationNate (r� h Pil„Jf4 � ng b � i cAr. Mf
5. IC uMllcrl arxla n'Irrlrro iiie 9;l nz^Il Maar°tolilcs stair lrs a,rura';rr;A< a fir. Irk r . r ry ^. ... f f �I S.. g °/.A,.N"t
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? ...........................
fgrpe of offense Where When
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty Other
7. Have you been arrested / charged with any traffic offenses in the last five yews?
r YpcH.. ufFgl Where When
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty Other
8. Has your driver's license or chauffeur's license been suspended or revoked in the Ila>C five, years? ...................
rype of offense.
Where
mm
9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provide the name(s) AIZ)
DEPAR"I"MIENT OF CIrtIMMAL IINVESTIGATION (DCI) IFCEPowir AND STAT C:EP' l-IFIE'D
DRIIMNG RECORD IIdII.UST ACCOMPAINY THIS APPII...ICATION FrOR PONCE CHIEF! REVIEW
You nnust apply for an uundivlduuae Department of CrIn iirnall innvesUpation Report (for" avaiNble upon reguueslt),
(SE',COM) PA":61f.':: IF' 011a. In;IEQUIPIC::Ji:U SIGNXrU, RE AND NOTARY)
IJIMAJIM
Page 2
?Wh�t I have issued to me by the Iowa J
i9 42- issued on 9�1.�explring on aq Itri j3 I understand that if I116110
*a**ka#k#k#*k##******#kkakkkk*###k*#R##tr*aA4xaaa###*k###YM*#*#k#aR4trkaak-*aa##*k*##k#kaaa*aaa*kmk*##a:hnk*k****k#**ksakkk*k##kY:akk*&aakaa*****kaaRk
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn tQ.,before me byAtr ...�...,_y_Ja.,.., on this ,mmRday of
M
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 he detrimental to the safety, health
or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code),
olive CL
Si nature of P hief or desi
g e If�auRr;
AFTER APPROVAL BYTi IE CITY CILII::'f K YOU ARE AAUTI IORiZEID TO (DRIVE A TAXiCAI:B IIN IOWA CITY l::rORt NO
MORE THAN ONE. YEAR l::ROM THE DATE l...lISTED BEI ...OW.
1'R lE IE'FPECTWE DATE vWl1...L IWIA,TCH T1 BE CHAUJI FEU R'S ILidENSI:: EXPiRtA"ll'iON OF LESS THAN A, MAR,
.M.
�r
SE rr ure of Ci Clerk or designee
Office Use Only
Approved application
DCI report
State certified driving record
Website update
CI.NTR %Rlr)RIVHADGP.APPI-O 4.imxndedJ?6C 02/2015
W,
Fe b. 18. 2015 1,56PM Div of Criminal Investigation
I � .. 11. 6 V LJ j. J/ 11 1 a V I l/ V 4 G 111 V I l y V I a V W G UILY
STATE OF i Dv
�,
c r s. History Record Check
IIIRequest Form'
Tw fovea D[visim of Crfmpaa@ ruvestiget(on
Support Cperatious Bureaea"111 Moor
225 R. 7'e Strut
Deg MON P4, Kowa 50319
(51S) 725-6066
(53.5) 7W-6000 Fax
M
UAM
No.0619 P. 3/4
No. )Diu F,
DC1AccountNumbersL1Lw)bcg—r
(Rif fiPPIRIMUM)
Protea. _C4orof%amaCs'tp
CRY Glork?a WEB
410 F, Washiafon Street
rawa Cltaa M 52240
Fhonea 319-3S6-5041
Fax: 319-356-5497
Agof--406 a search of the, provided name and date of butt► revoaled:
El No Iowa Criminal History Record found with DCT
r.a
Iowa Crinulul Matory Record attached, DCI
73CI ° °tialsx1b
Received Tirne7Feb: 11. X2015 9:35AM No. 1076
Feb.18. 2015 1:56PM Div of Criminal Investigation
IOWA CR,rM,r,NAL HISTORY
LINN CO 50
CHARGE NO- 01
IA STATUTE IA321J-2-2A
DCI
00715578
NON CONVICTION
TRK#: 5023000o1
COURT DISPOSI9CION
PAGE
1 OF 1
AGENCY: IA057DISJ
LINN CO DIST COURT
DATE
PRINTED-
DCT:00715578
2015/02/10
NAME: OSKAN,ALLASLUw MoSAxED
COURT CASE ID: 06571
OKCRO54231
DOB SEK RAC NET
WGT EYE HAIN
SKN
POB
19640418 M B 508
2'00 BRO ELK
DRUNK DRIVING SCHOOL
YY
A.j
OI ARRESTED 20040112
AGENCY: IA057000o
LINN CO 50
CHARGE NO- 01
IA STATUTE IA321J-2-2A
Owl IST OFFENSE
TRK#: 5023000o1
COURT DISPOSI9CION
AGENCY: IA057DISJ
LINN CO DIST COURT
COUNT NO- 01
IA STATUTE IA321J.2(A)
OPER VER WH INT (OWI)
/ 19T OFFENSE
COURT CASE ID: 06571
OKCRO54231
CHARGE CLASS: NON CONVICTION
TRK#: 502300801
DRUNK DRIVING SCHOOL
SENTENCE
DISP EFF DAT
DEFERRED JUDGEMENT
1Y
20040415
PROBATION
IY
20040415
DISCHARGED FROM
20041104
DEFERRED JUDGEMENT
AN ARREST WITHOUT DISPOSITION 19 NOT AN INDICATION OF GUXLT. THIS RECORD
MAINTAINLD BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF
IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW
ENFORCEMENT AGENCIES BY THE DCI.
IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD :FS
BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD
COVERS THE SUBJECT OF YOUR INQUIRY,
DIVISION OF CRIMINAL INVESTIGATION
No, 0619 P. 4/4
roDoi:
WWWAYC1
SMARTS' 9 5UI I (USTOMr.."
Office of. lViver Services
YO Ba, qm4 i noes in", IA 6I1: AA9204
F'kaow 515-244124 k 800�,r3':4121 tlF : 515-23,9 I'R37
www.imad,A..gov
2/12/2015
Osman, Allaeldin
Mohamed Yousif
26 ANISTON ST
IOWA CITY, IA
522402216
Mailing City/State: IOWA CITY, IA
522402216
(Certified Abstract of IDdving IRecolyd
DL/ID S: 782yy1942 (IA)
Ciasm D
Audit #: 7358959
Issue Date: 09/19/2013
Expiration 04/18/2018
Date:
Endorsements: 3
Restrictions: NONE
Date of Birth: 4/18/1964
Sex: M
DL States: VAL
CDL Status: None
CDL Cert None
status:
CDL Med None
status:
Restriction None
Supplement:
1 .07/21/201 a Obey Traffic Sign/Signal
Operating While Intoxicated Test Refusal/Test Failure Violations
ipr'tt,nrrai'tieH;:u ,>tOD
01/112 11 / 1. 2004 ...� A911 11 &4 _... tO
Sanctions
NTY;87� i/ectiv avroked 01131/2004
Name: Osman, Allaeldin Mohamed Youslf DL/ID: 782yy1942
.fest IFaiilwire
'll'ost Failure
1UR
Occlurr"Ince..fUR I€+T,!
Pursuant to Iowa Code.§321.10, 1, 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: