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Home My WebLink About15-007r Authorization Number I :�-_e- _ �` (Office Use Orly) pig" + Im111 CITY OF IOWA CITY APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday- Friday.) 410 East Washington Street Iowa City. Iowa 52240-1826 Failure to complete the 02 uirsd" 6nfofmat/on wit/i°estelt in dental t)f the �oezllG�tl[in (319) 356-5040 (319) 356-5497 FAX 1. Name (dl:_OUlltl.=D} First . Middle „ .:t Last 2. Mailing Address (REQUIRED) pp _ Na" My„� 6 3. Contact Information (REQUIRED) Email:(O g&I Cell Phone erg",, 4. Prior ex erten in trans orNa " 3 C .�. =�"�' .m,.,�• iii _... w.�.. �r, rwr�3 4��"+ 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere L,1 Tvoe 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? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? _. Type of offense Where When OR- Li t.;e ; 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five Type of offense _ ire W mob! �.�.� �;"m,�(' v 4...n 9. Have you ever applied gto bean Iowa City taxi driver using a different name? If yes, please provide the narfa"�(s) A'l C 4 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) 092014 I h rep certi that I aye �s ed to me by the Iowa Department of Transportation a valid Chauffeur's license number �,,,�/_! V t7 . I understand that if I falsely answer any questions in this application, that this application m y 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 9 PP r 7_ p.. 2 Signature Lica'"c,��1'.a s' < 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 ?cgov.org. STATE OF IOWA ) COUNTY OF JOHNSON )� °n 4 Subspribed and sworn to before me by t , On this .sem .�_ t �, � r••�.,.. . 11 sIm day of I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there o 1 ation which would indicate that the issuance would be detrimental to the safety, health or welfare of ide oft a City of Iowa City (Title 5, Chapter 2, City Code). or 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. Signatu of City Clerk or designee y 6N.5 _ ate Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/2" (width) and 5'/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update Clerk/rAYJDRVBAOGEAPPL92014am ded.DOC 09/2014 Mailing Address: Page I of 2 ui "DOT "UMN I acxitir ov fv; A,i T Office of CIV two seiv cms PC' Do' W04 Fbc; vi15-2"0124 �k MG"n2121 t F2C515P,7?4 TWT W,M,tDWaW-qw 118/2015 Osman, Adil M 102 WESTSIDE DR 102 WESTSIDE DR CIMM,rn oato ConvRcUon Daia 10129/20111 Name: Osman, Adil M DL/ID: 249AD2618 DL/ID #: 249AD2618 (IA) Class: D Audit 8: 6455092 Issue Date: 11/08/2012 Expiration 10/26/2015 Date: Endorsements: 3 Restrictions: NONE Date of Birth: 10126/1969 Smxs M History Information CDL Status: None CDL Cart Nons Status: CDL Ned Nonz st�tus: Restriction None Supplements ,S92 Sjpeed Whinson TA l@I':114 Fall t 0 01h e Y Traffic Sgn/S�gn a J Mlhinsan 1A Pursuant to Iowa Code §321.10, 1, Kim Snook, Director of Orrice or Driver Services, Iowa Department or 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: 1/812015 . ,gym: i; D. 0. 6 .......... Office of Driver Services Iowa Department of Transportation Name: Osman, Adil M DL/ID: 249AD2618 1/8/2015 DCT AgxonntNbmber; � - �""°" Tog X® p DIVI®loa of Crhnlhal 111yes"gation Frouml CI otlowa 40— Support OparationalluYea0g,VFlaor CItyClerilpaQD La 215MI'Streat _410 M WaelRtm uu t Dee moblegiaIowa 50319 515 9 -6066 lows G 1, 42x0 (518) 4.6000 Fax phougm 319-356.5061 i:axi 319 6-5197 ears aut aau Io 01ml l fflaifmRecord Check ow —__---_____ Att.9gameOdM9.fldqe N I� �YIf6�a81 �1.� 619-ZL1q6q Lbe%alo "--=[L ---------- — ------------- dldv w .7 �darsna8 ots. ithouat W don a6 walreu tVeomm Clue ealulneft nt tha vetoes a aOMplate outmmIna I Mabry reeaA may mot bereleaswlrole, per Coda of Xoeae, Chuptor 69,2 For Lwa ed minal lilatoey roaos b(ormaatllom, as allowed by law, allways dIlver. 91909a: 1hady ONO PufflWY&AWho64Wro1XIVan agg6W""14daaaea1rrXmyogaedmguRalWOUT r4ditakwfikh ate Dleurn frovimtnag PmtamsuieegFarmQIS�I.I..Ami�m¢Iialnimi®9ao Ilntm�aae �,YaYnllg,m Ym��Ilmfm"v kyaaw�D�'GumasyOmeON �ma016 1,71dw. 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LV IJ I�IVI1A va c v. 4111 VI\H VI aVWU VI, HV, JJ IV 11 LI2 DCT AgxonntNbmber; � - �""°" Tog X® p DIVI®loa of Crhnlhal 111yes"gation Frouml CI otlowa 40— Support OparationalluYea0g,VFlaor CItyClerilpaQD La 215MI'Streat _410 M WaelRtm uu t Dee moblegiaIowa 50319 515 9 -6066 lows G 1, 42x0 (518) 4.6000 Fax phougm 319-356.5061 i:axi 319 6-5197 ears aut aau Io 01ml l fflaifmRecord Check ow —__---_____ Att.9gameOdM9.fldqe N I� �YIf6�a81 �1.� 619-ZL1q6q Lbe%alo "--=[L ---------- — ------------- dldv w .7 �darsna8 ots. ithouat W don a6 walreu tVeomm Clue ealulneft nt tha vetoes a aOMplate outmmIna I Mabry reeaA may mot bereleaswlrole, per Coda of Xoeae, Chuptor 69,2 For Lwa ed minal lilatoey roaos b(ormaatllom, as allowed by law, allways dIlver. 91909a: 1hady ONO PufflWY&AWho64Wro1XIVan agg6W""14daaaea1rrXmyogaedmguRalWOUT r4ditakwfikh ate Dleurn frovimtnag PmtamsuieegFarmQIS�I.I..Ami�m¢Iialnimi®9ao Ilntm�aae �,YaYnllg,m Ym��Ilmfm"v kyaaw�D�'GumasyOmeON �ma016 1,71dw. '�dl�id�i�,�'.adAAlfd9�'�g _ ____�._ _.w...._...�._.___,_..____._.__..._,a.w.____ ...v.______ 'a 0 0�f-----------�-- ......a, eemaoh o:(`4ho prq`Oialeit nuaw and date of Wdh Weabed�'" a, N6 'Iowa OhdWHf9oryRWordfbUadVdthDCT lown. tarn " al : toaq.Reoord aftahed, DC'°1 # -------------- DCI dek, a i v e d T i me—Jan. 5.-2015— 1:451`Rr a, 733'1 ------ --------------- ________ Def -77 l0erA5110 i