HomeMy WebLinkAbout14-172Authorization Number
i (Office Use Only)
r'
t wIII ovvawi
r
CITY OF IOWA CITY APPLICATION FOR TAX]IMOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made
410 East Washington Street between 8 a.m. to 3 p.m., Monday—Friday.)
jo�w�,.aa _City,. Iowa 52240-1826
'1319) 356 5040
`-�..._...._._.-6 40.,
(319) 356-5497 FAX
R IMiddle m ILast
1. Name __ dd�_-----___q�
2. Mailing Address _-- ; _----- !ak__ _ ______ ��__ __ 13___�_ -------
3.
____.
3. Telephone: HarmeV`--- ---------Other
4. Prior experience intransportationof passengers:. :__________________________________ __
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? NO
Where
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?4ZO_
7. Have you been convicted of any traffic offenses in the last five years?
I
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /LO
Where
1
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)
d.M.dddwadg 03/2014
i that he ions Department of Transportation a valla Chauffeurs license number
I herebyfrt �)I have issued to me by tI understand that if I false) 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 O 17 "2o (t "f
YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY
CLERKS OFFICE. Authorized taxi driver names are placed on the city website at icgov.org.
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by On thisP, ,,;E.; ),; ,_............. day of
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).
SirAre of 13 I c /Chief or designee
F,
r.�r�te-
YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY
CLERKS OFFICE. Authorized taxi driver names are placed on the city website at icgov.org.
Signature or
designee
..............................5. w .................................
t'DaYa�
Taxi cab businesses are required to provide Oriver Identification cards. Cards must be 8%" (width) and 5'/s"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
wer:v1aWnvbaageapp2014.acc 03/2014
IAua.A8. 2014 12:49PM CDiv of Criminal Investigation
STAT)g
�OIlVl � � M
a
II .rr` r' r ��co i
1 �
Request
To; ow Division of CrImIntil Investigailon
�Support Operations Bureau,i
215 F. Jo� Sfreaf
Des Mofila, Iowa 50319
,3
725-6080 Fox
I sarou.rc. qy .........................................m....M m
msiTari w aflf ]Itf�w"wa�°ufaaumal 131.:tory f�.ea.annel �Waa;uV� sera:
.¢...... ... ...,.,�................. ...........................
ry( qy,, k✓�H' .Jti"y°M1� rA"�� �p 11 ,,pp 44pp����"r/�xxII.e �'pttPWPf4�ibN
TASt Nas.true. R%Aek Ago a"st.
...,. 14 h
R/fil ii CJ
NNo;1633 p P. 2/4
...., (Cm
DCI Account Number: ""
Qnmr�mgnuW�abnry
frees, r: of
0ty Clarkle Me
410 1L, Awa AlI fop, uaef
IOWA TA 4224A
Phone: '319 3565041
..........................
ttnx: 3.1.9 356 9497
�'` a4-'aa5 2 9'0'
t :a�le ��t�mama > .
f4 tsf'useyd of ffyffFsffa Without an slganod wmaawver 11-01vn ffae 604eat of flfn.e seq uPit, a ernauaP fe eu-unnpunaf hieforry aaa;ord paae,y not
The releaable, PW'Cade of ta waj Chapter 692,1 �twar �a , nlefe eurWinal futstmmy record 6usfor m.oftn, as ntWbwed Ivy Nw, a;.wrfayue
albUdli a walver egaamatnrte 11romm tlh,a owr6toot any Um reaaurwt.
FIf alver Redease; Ihueby glvc Pcrmfasloa for the above requesting ofrlclal to conduct an Iowa cifminal hlstoryRoord chock with the DWisron oFClmsinel
h,vesllgatlonoDcq, MyplminalhlstoryWeconamin`nterhaticmafatalhodby Cho DClmaybordmcdaeellowdbyla%
waiver
lowa ......, ....... 4 tux R� smi �Dcresc�„(r�
As of' "' "'� a search of die provided name and date of birth revealed;
a., r
D low, Crhninal7C btoiry Recouf Bowd'rwith DCT
Iowa aiminal Histoxy Record attached, ,TDi..fl r
iC.9%trruati'aqs
D( -T-77 (OR/25/10)
Received Time Aug.13. 2014 1:OOPM No -6921
'10VIEW
i
0, 11111111111111
•.w„ '"" a r Ir l w,. t �" , it (I//V%/ b'If,)W )!(.jIP,)�' P /)
wW�91lt6V �& af,�WII d 1 (..q.,h:r (MV )r" )iE'�I �I'� 8 ��m ����� ����..��rv, ��wn.w
4 mr16c'eoil& III ry Lll ser'vl c'['vS
N r r 14C,Ira "Q01 V I li�trta&Irlrur�a i t r f 4,@b9-,31,tu�Y It
'1VVrwWA01�rK30rrr.ryi N
Certified AIIIStraa:t of 1Driiviling (Record
Inquiry [gate:
8/13/2014
DL/ID St
569AG6549 (IA)
Name:
Osman, Mohamed
Class:
D
COI(. (Med
Ibrahim
Statuum
Addressr
2425 BARTELT RD APT
Audit dr
5696549
2C
Issue ®ate:
12J21/2011
City/State:
IOWA CITY, IA
Expiration
08/21/2016
522462709
Date:
Endorsa entm 3
Mailing Add sr
2425 BARTELT RD Air!
Resivictionso
NONE
2C
Date of Birft
8/21/1966
Mailing City/ ter IOWA CITY, IA
Sexr
M
522462709
DL Statuar
VAL
CDL Statauar
None
CII. Cart
None
Statusr
Iowa Department of Transportation
COI(. (Med
None
Statuum
(Restriction
None
Supplements
Accidents - Accident invahreutreat indicated does NOT (mean the Individual was at fault or given a citation.
Accident nt 17aM h Case fturrli8elr' .... HIR .... ....
0511 2/20:14 798599 A
recordoffice,r that I have been .e by Director Department of
Transportation to so certify.
In witness whereof, I have caused my signature and the seat of the Department to he set upon this document, at Ankeny, Iowa this
date:
EQ m
8/13/2014
pp T a
w"
m"
gems
Office of Driver Services
Iowa Department of Transportation
Names Osman, Mohamed Ibrahim DL/IDs 569AG6549