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Home My WebLink About16-037I r IDENTIFICATION NO. I, — 03' - (Office y}(Office Use Only) CITY OF IOWA CITY APPLICATION FOR TAXICAB / 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 "required" information will result in denial of the application (3 19) 356-5040 Q 19) 3S6-5497 FAX 1. Name (REQUIRED) - 2. Address (REQUIRED) First 3. Contact Information (REQUIRED) Email: «,,,j Cell Phone: (RT 53U - 171+0 (All written communication sent via email) 4a. Chauffeur's License expiration date (R b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: _ 1 Z ' ewrs 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? /I CiC Type of offense What happened to the charge? (Circle one) Where Convicted Dismissed Deferred Suspended Plead Guilty 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where When Other All) What happened to the charge? (Circle one) era Convicted Dismissed Deferred Suspended Plead Guilty "Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Lo - 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 nameiP 11 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). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Depart ent of Transportation a v lid Chauffeur's license number '1 `� 2 YY qt, t Z issued on 5 J expiring on y1/9 . 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 em loyees of the City of Iowa City Iowa, in their discretion, to examine any and all records and documents relating to this appl tion, and I further agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisions Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant — Date 23 fb STATE OF IOWA ) = a COUNTY OF JOHNSON ) /� / // ,n Su bed and sworn to before me b R I C4 -e lel/ j, 0191! jyicz� ` . �y� Y on this day of 42_KELLIEK.TU ``-C.6 e K717tt -( commies on Number Public in and for the State of Iowa 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). Expir ion d of auf eur's license g J j� j j Signat Police Chief or designee X12- 2?-- /6 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. Signa re of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update 02-2 3 -i„ Date Clerk/ AxIoRJVB AGE PPL92014amendedDOC 03/2015 F,eFebll. 2416w10:09AM�,�r�Div of Cri.mioal Investisalloo - 02/0B/2o1e: 13;0Nc �'�' 711 Jg97 P. .SD2/oo2 STATE OF 1OWA. . � Cri�iH31 Histoii-y Rvc,ol'd Check Y s ,R' Requeglt +(Fruit Tn; Iowa DiviNun of Criminal Invesltga(ioa Support Operations• ldureau, 1" )door 215 L. 7" Street Ties Moines, lows 50319 (515)125-6066 (515)725-6090 Nag Last %IT 05)1)a)I oil: �trst 1Vame (mands Aflclelcil'I1 DCl Account Number: (if applicable) From; C'ity_of losva Ci( CiOfac_0 - 410 E. Was)liltgn Street - cry --- Iowa Ci(Y, 1A 52240= Phouel 319.396.5041 Tag: 319-356-5497 fti �~ T fiddle 1Va ie Nlolirwi ed t/vt(Si C1 Date of Birth(,nandalory) GeIl(ICr (mandatory) 3ocial ScruritV Number (molayl��l�t�6L� Wale ❑Female % - q 1 - 3 ✓ � Z Waiver r~-nforntaltOfl: Without a signed wah,er Cron[ (hesubject of the request, a ca np)ete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. Por complete eriminai hisfory record fnfoimation, as allowed by late, Mwayg obtain a walversiana[ure from the subiect of the r•e�+,a�l I'I ah,cl• Re/CpSe. I booby give permission for the aba a Wresling 0i' l to oonpucl vi Iowa criminal hisloly record chn k wi[h+hn Division orc limiam Investigation (DC]J. My criminal history dela eromerning n I lis maintained by the DCJ may be released as Sllotccd by laq, Weriver Signature: - � Iowa Criminal H, W' - v Record Check Results (ncr+nnor,ly) As of __ a search of the provided name and date of bir(h revealed: 13 No Iowa Criminal ITis(ory Record fowld smith DCI -, i Iowa Criutin2l History Record attached, DCl (5y-jg 751' • w ., DCI initials f, Rectived Time Feb. 8. 2016 11:52AM No. 7087 Feb. 11 2016 10�09AM Div of Criminal I n v e s t l g a t i 1 n ADDITIONAL IDENTIFIERS SC R FGR CCH RECORD k** 01 ARRESTED 20040112 AGENCY; IA0570000 LINN CO SO CHARGE NO- O1 IA STATUTE ZA321J-2-2A OWI IST OFFENSE TRK$(: 502380801 COURT DISPOSITION AGENCY; IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE: IA3210.2(A) OPER VEH WH INS (OWI) / IST OFFENSE COURT CASE ID: 06571 OWCR054231 CHARGE CLASS: NON CONVICTION TRM 502360801 DRUNK DRIVING SCHOOL SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 1Y 20040415 PROBATION lY 20040415 DISCHARGED FROM 20041104 DEFERRED JUDGEMENT AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI, IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY, DIVISION OF CRIMINAL INVESTIGATION �1 No 7113 P. 3 m IOWA CRIMINAL HISTORY DCI 00715576 M. NON CONVICTION PAGE 1 OF 1 DATE PRINTED- 2016/D2/Y1 DCI:00715578 NAME: OSMAN,ALLAELDIN MOHAMED DOB SEX RAC HGT WGT EYE HAIR SRN POB 19640418 M B 50B 200 BRO ELK YY ADDITIONAL IDENTIFIERS SC R FGR CCH RECORD k** 01 ARRESTED 20040112 AGENCY; IA0570000 LINN CO SO CHARGE NO- O1 IA STATUTE ZA321J-2-2A OWI IST OFFENSE TRK$(: 502380801 COURT DISPOSITION AGENCY; IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE: IA3210.2(A) OPER VEH WH INS (OWI) / IST OFFENSE COURT CASE ID: 06571 OWCR054231 CHARGE CLASS: NON CONVICTION TRM 502360801 DRUNK DRIVING SCHOOL SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 1Y 20040415 PROBATION lY 20040415 DISCHARGED FROM 20041104 DEFERRED JUDGEMENT 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 BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY, DIVISION OF CRIMINAL INVESTIGATION �1 No 7113 P. 3 m t�5 M. Z Uva DQT '.IfAA lTFR k 5#!'9f `A 1 _i „ (i F r- ,trlrl Office of Df Iver services FO 8cx 9204 1 Des fumes, IAC, i0e-92n4 P one:515.24-0-:9t24,2GG-:32.-t €'<t]Fax.=515-239-?E;37 iv ex k v8 d:7::, _I o v Certified Abstract of Driving Record Inquiry Date: 2/23/2016 DL/ID #: 782yy1942 (IA) CDL Permit Class: None .:Wt 9�r'"••" Customer #: 3963874 Class: D CDL Permit Issue None Date: Name: Osman, Allaeldin Mohamed Audit #: 9111703 CDL Permit None Yousif Expiration Date: Address: 26 ANISTON ST Issue Date: 05/26/2015 CDL Permit None Endorsements: Expiration Date: 04/18/2018 CDL Permit None Restrictions: City/State: IOWA CITY, IA 522402216 Endorsements: 3 ID Status: EXP Mailing 26 ANISTON ST Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA 522402216 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 4/18/1964 CDL Cert Status: None Sex: M CDL Med Status: None r-� History Information -- -inzz z Convictions --, r10 c.a Cv Yact 4F Date Aco ExulanationdUF'ff q-, nffa '01/12/2004 04/07/2004 A20 Deferred Judgment OWIi•L�n .. `••' IA 103/26/2012 04/20/2012 - - S92 Speed - .. Nefferson IA 05/19/2014 07/21/2014 M14 Fail to Obey Traffic Sign/Signal Johnson IA Name: Osman, Allaeldin Mohamed Yousif DL/ID: 782yy1942 Pursuant to Iowa Code §321.10, I, 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: .:.......wW,lr 2/23/2016 IOWA: D. 0. T,: r .:Wt 9�r'"••" Office of Driver Services ,r`......R,r� Iowa Department of Transportation Name: Osman, Allaeldin Mohamed Yousif DL/ID: 782yy1942