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Home My WebLink About16-111°• W11®i�Il rt.as._ CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) IDENTIFICATION NO. / Lo (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 First 3. Contact Information (REQUIRED) Email: MUMM 4a. Chauffeur's License expiration date (REQUIRED) 1I f/ ?-"I ;z b. Taxicab Business Name (REQUIRED) {A��yw�a _ %gL 5. Prior experience in transportation of passengers: Phone:�'l�I =517q - 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type 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 years? !V 4? Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred SuspendedCthe y Other 8. Has your driver's license or chauffeur's license been suspended or revoked iyears? _ Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please prow de.the p' me(s} - N/ /7 DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIF(EO DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REV{EW You must apply for an individual Department of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0212015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby ce fy that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number issued on[�expiring on I understand that if I falsely answer any queens in this application, that this app ication may be denied. a ree 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 ==r pj Date/ STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by fye 56 . h • O �1ahaMry �e on this -7 day of -tel .--A 7_c0 1 n 1 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). license 01'01' 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. Signof City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update cr r ClerkfrAXIDBIVBADGEAPPL92014amended.Doc 03/2015 CIowa Department of Transportation Ofte of DRVer SenwAs {toll keel K* 532-1121 PO Box 9204, EftMW". IA !10306 9264 515-244-9124 AW PAX: 513-2391 W Convictions Citation Date Certified Abstract of Driving Record ACD Inquiry Date: 4/20/2016 DL/ID #: 582AH0582(IA) Customer #: 5930422 Name: Mohammed, Nasr Class: D ID Status: None Adder Osman Oshar Address: 2610 BARTELT RD Audit #: 8142283 DL Status: VAL APT 2C Issue Date: 06/06/2014 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 01/01/2017 CDL Cert Status: None 522462731 Endorsements: 3 CDL Med Status: None Mailing Address: 2610 BARTELT RD Restrictions: NONE Restriction None APT 2C Supplement: Date of Birth: 1/1/1980 Mailing IOWA CIN, IA Sex: M City/State: 522462731 History Information Convictions Citation Date Conviction Date ACD Ex lanation Count ]UR 01/25/2015 02/12/2015 M70 Im ro er P",m Johnson IA Name: Mohammed, Nasr Aldden Osman Oshar DL/ID: 582AH0582 Pursuant to Iowa Code §321.10, I, Melissa Spiegel, 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 on 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: y tf� 4/20/2016 ►, .., + > IOWA,';: c_. Office of Driver Services _ wrta^ Iowa Department of Transporation - I Ul Name: Mohammed, Nasr Aldde, Osman Oshar DL/ID: 5B2AH0582 ry �J nut• zI• [ulu e�Urtivi ulv of �rlminai Investigation No. M) r. 7/y Erom:Clty al Iowa Clay Clerk O/flee 310 ZBSS.av7 an/2a/2a/C 0@:37 0478 P.002/002 STATE OF f OWA I Crinlfiial History Reco��d Chcek 0E � Request Forth To: [own Division oforirninal lnvayli�atinn SrtpflOrt Uperations 13urcau, 1al F1 our 215 r, y` Street Des Alotuos, Iowa 50319 (-q 5) 725-6066 (51 S) 725-6000 Fax 1)C:1 AccDun I NIimbe,; 0 (ifapplicnhle) Rrum; City Clcrlds Office 410 P. Washln ton Street LlljY CMA 52240 Phooc; 319-356-.5041 Fax: 319-356.5497 - --- am re testing on lovva Criminal Histol Record Check on; Last Narne (piano„logy) i ilsE 1�ame pnaaaalory) �I — Middle Name (letumincnded) a%(v( �1 yvi A acfi c) Dale of Birth (mDndeloq') Gander (O aneatom) 1 Social Securi 'Number (re anm, ndu 111/0(/ 1 g d ®lklale OFemale ��'rJ - Waiver in ,formation: NNlthout a signed maiver from [be subject of the request, a comple(e criminal history record may not be releasable, per Code of Iowa, Chapter 692.2, For complete criminal Illstory record information, as Allowed re lead, alwaysyno obtain s H afver sSenature from the subject of the request, 1�/alVCr %(('ICRSC, t hcre6y givepennissien fv the a6ovo requesting official m conduct an Iowa giminal gislurr rrcore aleck wish Ne Uivifion n/Criminal hwcsligatial (CaC1), Any w urinal histD data conctt 'Y ping ane shat is nlainlaincd by the DCI maybe mlea:ed as allOqcd bylaw. Waiver Signature;- , - I Iowa Crifflillal ffistory Record Check Results / MCI Ilse Only) As of --- �21�ii f. seareb of the provided nalne and dale of birth feve,;Ird: l ...' ra No )°We Qiminal I3istory Record found tvilh lJC] � • �1 lot�la Crirnindl I-]islaq Record attached, DO # � r �.-- cr:• c 3 DC] initials UU'',, -UCI-77 (05/25110) --- -�.-- ! — -- -- -------- �.-- i ter+ RP f P I Voll TImA Apr 90 9016 P- MM No. 97(15