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Home My WebLink About17-032IDENTIFICATION NO. ) -L - F) 3 7 - (Office (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 (3 19) 356-5497 FAX Fir t Middle Last 1. Name(REQUIRED) ALTAFLDJM M CXmayl 2. Address (REQUIRED) ;2? ANIS�pN A '5 LtO 3. Contact Information (REQUIRED) Email:Coro Cell Phone:(31g)g.29c)2 (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED)II OHJI j7/?o 1,9 b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: (D �lFa ✓6 M4 ttle �%a lej, 6. Have you ever been arrested/ charged With any misdemeanors and/or felonies in this State or elsewhere? AID 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? 10 4L Type of offense Where When SP),--ej J4so0 lj} 3j261201 2- 16Z, Fe:L -to o x� 7raF%rrc sisN�si�nal lolnhSov� S��I ?v l G{ What happened to the charge? (Circle one) 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? AL 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 name(s) kV 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) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number �a'2 �Y 19 t� Z issued on expiring on I understand that if I falsely answer yanr questions in this application, that this application may be denied. agree th ate 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 appliand I further agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisions o=15, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant r Date 2 LA7 bo I STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by Aljlctel�j,4� K.Y, Q(atoK on this day of 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). 2/2 FI/q- 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. Signature of C Clerk or designee Date 11.1fiyyH.MYfT4fi kN}.y.yry..N1MYYlYflfffl11Hf1f11f1i}I}.}R1f}it}M.1f.1NHN11ff1ffl1f.f1f1.1ff11.Yff Y ^ Mi!}ffllfilY).HtHl.Nlffffllffflf Office Use Only Approved application DCI report State certified driving record Website update Gen✓ AXIMNae GenPa9201aa ded.Doc 07/2016 Y ^ � 0 Gen✓ AXIMNae GenPa9201aa ded.Doc 07/2016 C4J10WADOT R M WWW,IOWBCjOt 90V SMART 1PLER E 51 1 CUSTOMER DRIVEN Inquiry 2/24/2017 Date: 522402216 Customer 3963874 Birth: 04/20/2012 Name: Osman, Allaeldin CDL Permit Mohamed Yousif Address: 26 ANISTON ST City/State: IOWA CITY, IA Issue Date: 522402216 Mailing 26 ANISTON ST Address: Malting IOWA CITY, IA City/State: 522402216 Date of 4/18/1964 Birth: 04/20/2012 Sex: M Convictions Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-2449124 1 800-532-1121 I Fax: 515-239-1837 www.iowadot.gov Certified Abstract of Driving Record DL/ID #: 782yy1942 (IA) CDL Permit Class: None Class: D CDL Permit Issue None County JUR Date: 04/20/2012 Audit #: 9111703 CDL Permit None 05/19/2014 07/21/2014 Expiration Date: Fall to Obey Traffic Sign/Signal Issue Date: 05/26/2015 CDL Permit None Endorsements: Expiration 04/18/2018 CDL Permit None Date: Restrictions: Endorsements: 3 ID Status: EXP 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 03/26/2012 04/20/2012 592 Speed Jefferson ',IA 05/19/2014 07/21/2014 M14 Fall to Obey Traffic Sign/Signal 'Johnson IA Name: Osman, Allaeldin Mohamed Yousif DL/ID: 782yy1942 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 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, pt Ankeny, Iowa this date: T ,2CO VEtll�lf °W CO 9 ' IOWA •,I 2/24/2017 .-r� m 1'1 :O D. 0. T. -W �,Q�iea�rl q ......:< Office of Driver Services . - heb.11. 1011 10:55AM Div of Criminal Investigation No.4508 N. 5/6 1`rop•. •��hY arr i�wa .,ny Cl ar.c �rnioa arar sn{yp4tl/ 02/22/2017 17:49 0e41 P.002/002 STKEFO IOWA Criminal History Record Chec @I ,> r,, Request Form DCI Account .- TO: Iowa Division of Criminal Investigation Frams Cityof Iowa City _�,___ Support Operations Bureau, l" Flom City Clerk's office 215 E. 7a' Street 410 G_Washin on Sd•de[-.._4__ Des Maines, Iowa 50319 725-6066— (515) 66-'-(515) 725-6080 Fax Phone: 319-356-5041 _ Fax: 319-356-5497 T 4", rwnnPctinR An town (YB11111a111ionhV Record Cheek )It. Last Name (mandatory) First Name (1naodatory) Middle Name (recommeaded) n5Ync?lY) AI�c,e ✓1'r'1 �(1U�IClV✓le(� ��uit5� Date of Hirth (mandatory) Gender (mandatory) Social Securi ' Numher secormn0dcd) P26 Waiver Infdriridfion7 Without a signed walver from the subjeet of the request, a complete criminal history record may nal ba releasable, per Code of low a, Chapter 692.2. For complete erahint ivaI history record information, as allowed by Ian•, always obtain a waiver signature from the subject of the request. Waiver Release: s hereby give pesmissiun for it .hove requesting of iel to condw an Iowa criminal history mord check with she Division of Criminal history data met is by the DCI may be as Mowed by law. Investigation (DCl). Any coming) ceneem n'ttc maintained mleased Wn1Vel'.StgMal�.A) IowaCriminalHistory Records Check Results (Dc) use only) As ofepi 1c�i1 \�� a search of the provided name and date of birth revealed: 13 No Iowa Criminal History Record found with DCI -i; (fl Iowa Criminal History Record attached, DCI DCI iulitials 4C — DCI.77 (08/25/10) Received Time Feb. 22, 2017 4:25PN No, 4187 he b. Ll. 1U II IU:77RIVI U I v of 6r I M I n a I I n v e s I i g a I i o n IOWA CRIMINAL HISTORY DCI 00715578 NON CONVICTION PAGE 1 OF 1 DATE PRINTED - 2017/02/27 DCI:00715578 NAME: OSMAN,ALLABLDIN MOHAMED DOD SEX RAC HOT WOT EYE HAIR SKN POE 19640418 M B 506 200 SRO BLK YY ADDITIONAL IDENTIFIERS SC R FGR vo.47UG r, o/o CCH RECORD *•+ 01 ARAESTED/TAREN INTO CUSTODY 20040112 AGENCY: IA0570000 LINN CO SO CHARGE WO- 01 IA STATUTE IA321J-2-2A OWI IST OFFENSE TRK#: 502380801 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE; IA321J.2(A) OPER VSH WH INT (OWI) / IST OFFENSE COURT CASE ID: 06571 OWCROS4231 CHARGE CLASS; NON CONVICTION TRK#: 502380801 DRUNK DRIVING SCHOOL SENTENCE DISP EFF DAT DEFERRED JUDGEMENT lY 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 F.a r -a R't 7 J CD" 7