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Home My WebLink About15-304r CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED 3. Contact Information (F IDENTIFICATION NO. _1'15 — � 622 (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) Failure to complete the "required" information will result in denial of the application MI (All wr 4a. Chauffeur's License expiration date (REQUIRED) b7/ IJ 120� b_ Taxicab Business Name (REQUIRED)_ 11111V(' 5 Caf 5. Prior experience in transportation of pa/s�sengers: T" pt1nIP 1� ccmrty �f I�Rk5� t&(-11,T!Iygy1d ICavi5�(W QWke(1 inp( b� i-Cjrl�1�(`i9¢rol f(om VIt(IJAJ Vgr 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When pin glc�h�l i -a YlC'(Soy� y4y); I A Oct.3) S1 Ali>uy'1� 1 d;b M lowligl f�u �,1Goh , 6ec�Kse I wit b(c'I�'�li i V 5;fua What happened to the charge? (Circle one) ;Convicted-) Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / changedi changewith any traffic offenses in the last five years? _ Type of offense What happened to the charge? (Circle one) When 1 Z /I ,vGQ —57il60 Convicted Dismissed Deferred Suspended PLOad Guilty Other qld f)w fiGke� 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? NO 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 natiiab(s) /vO cn DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CEMTIPIEW DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIE'fs+R,tVl lf�l You must apply for an individual Department of Criminal Investigation Report (form availabl6tippn re -quest): (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) _ Un <: 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify,that I have issued to me by the Iowa Department of Transportation valid Chauffeur's license number 0-7 5 dB7 I � issued on 0 /00 expiring on Cz- I understand that if I falsely answer any questions in this application, that this application may 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 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 a Notary Public) Signature of Applicant �Jf%L� Date (212 q l2d5 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by t, In Ara C C-)1kocQF nk1 L on this _�_ day of \10 r- _), C T 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 Chauffeur's license 2 322 t2 7) t Signature f Police Chief or designee Date AFTERAPPROVAL 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. �fi<� Sig of City Clerk or designee 12\� p�t� Office Use Only ti Ls cn Approved application Fr� DCI report State certified driving record cj Website update -� a ClerWrA%IDRIVBADOEAPPL92014amended COC 03/2015 Dec,23, 2015 9:36AM Div of Criminal Investigation or P. 1/2 +�rofrtiLlly Or IOWH UI[y GOrK Uil loo 31® 366Ea97 12/21/2016 17:09 •-'361 V.002/002 STATE OF IOVV . Criminal History repord Cheek Request Forin To: 1nWa division o1Crismnoi Investigation Snppnrt Operatlans ttnreau, I"r Flow, 215 t. 71h Street Des h4oine1, lows 50319 ($15) 725.6066 (515) 725.600o Fax Criminal WIOMO Check on: f)Cl Acenunl Number: _ CQ -7. - (if applicable] U1,01m City of lows C4(Y City 41orh's diffice —�"'-- 410 F, washhStreet Iowa City, lA 52240 1'11611c: 319-356"5041 rax: 319-356-5497 - ' —T"-- 0SA4 t'dlale ❑Fewale I i j'Vaiver hiforntafioa: Without a signed waiver from the subject of the request, a complete criminal history record map hof be releasable, per Code of lona, Chapter 692.2. For complete erlmin al history record information, AS allowed by lain, always oblaln a waiver siknatare from the subject of the reouest. Wai per Release: I here bygivc permission ror the above regnes(Ing official m conduct an Imes criminal blslory record cheek 101h the Division or Criminal Invcsligation(JIM). Any criminal history da,a concerning me that is maims' ed by Om bCl Ina) be re leased as allmred by laly, 'f I%VniverSignalru'e: � �J--�— I 1 �k� �— Tows Criminal History Record Cheep results - fLU use only) [As a search of the provided name and date of birth revealed ❑ No lours Criminal j-lislory Record found with DCI Iowa Criminal history Accord attached, DCl #_ R42-Lic-)y_ rJ DO initials ICI -77 (08/2910) Received Time Dec. 91- 7015 4A 1 P Ao.5R14 rQ ' c� Dec.23. 2015 9:39AM Div of Criminal Investigation No. 3956 P. 2/2 IOWA CRIMINAL HISTORY DCI 00942454 MI9DEFSEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- 2015/12/23 DCI:00942454 NAME: ABDELOALIL,MIHYAR OSAKA DOB SEX RAC HOT WGT EYE HAIR SKN POB 19900510 M W 510 139 BRO BLK LBR yy ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD ++• 01 ARRESTED 20111030 AGENCY: IA0850100 AMES PD CHARGE NO- 01 IA STATUTE IA123.47(4) SUPPLYING ALCOHOL TO PERSON UNDER AGE TRK#: SB00EJP01 COURT DISPOSITION AGENCY: IA065015J STORY CO DIST COURT COUNT NO- 01 IA STATUTE: IA123.47(4) SUPPLYING ALCOHOL TO PERSON UNDER AGE COURT CASE ID: 02651 SRCR046436 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 9B0080'P01 SENTENCE DISP EPF GAT FINE $500 20120111 SC $175 + COSTS 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 BE RELEASED TO NON-LAW ENFORCEMENT AGENCIES BY THE DCI, IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS EASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SU6JECT OF YOUR INQUIRY. ` DIVISION OF CRIMINAL INVESTIGATION it ra+ G Cil lam, CD, Z:i - �I C410WADOT www,lowadotgov Office of Driver Services PO Bar'. 9204 Des Moines, IA 50306-9204 Phone- =15 7.44-9424 1800 5,K-1121 1 Faze 515-239-11337 www.towado'.gov Inquiry Date: Customer Name: 12/29/2015 4508990 Certified Abstract of Driving Record DL/ID #: 075887217 (IA) CDL Permit Class: None Class: C Abdelgalil, Mihyar Osama Audit #: 8046040 Address: 2410 ASTER AVE City/State: IOWA CITY, IA Convictions Issue Date: 05/06/2014 Expiration 05/10/2022 Date: Endorsements: NONE CDL Permit Issue None Date: CDL Permit 522406731 Mailing 2410 ASTER AVE Address: None Mailing IOWA CITY, IA City/State: 522406731 Date of 5/10/1990 Birth: None Sex: M Convictions Issue Date: 05/06/2014 Expiration 05/10/2022 Date: Endorsements: NONE CDL Permit Issue None Date: CDL Permit None Expiration Date: Restriction None CDL Permit None Endorsements: CDL Permit CDL Permit None Restrictions: ID Status: None Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Supplement: CDL Permit ELG Status: CDL Cert Status: None CDL Med Status: None History Information Citation Date Conviction Date ACD Explanation County JUR 12/11/2013 '01/16/2014 ,515 (Speed IT Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number 3UR D6/22/2013 _.. 745610 -.. IIA..... Name: Abdelgalil, Mihyar Osama DL/ID: 075687217 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa DepaRment of 3�anspor.Fation, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this is'=i jLue aind accurate copy of an official record currently in the custody of said office, and that I have been authorized by the DirectiN'aFtheoia Department of Transportation to so certify. C7 In witness whereof, I have caused my signature and the seal of the Department to be set upon this�doegmenT_ )Dat Ankeny, Iowa this date: ter) 0euihic� o.;io,