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Home My WebLink About12-014CITY OF IOWA CITY 410 East Washington Street Iowa City,...lnxa.-52240- 1826 _74L9j3S6-SO4t ///Z_f'� (3 19) 356-5497 FAX 1. Name Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) Last (Office Use Only) 2. Mailing Address 21/ 11 IJAI5per i q NeadCJUi DY' 3. Telephone: Home 311 -'125 b / 12 a 0 Other: — 4. Prior experience in transportation of passengers: �41t4,I0S l F/ I/e- �/ Pl/Y ; ✓1 TAX l Cab of tA0 10 elm �a a> ea 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? ND Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years?. Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? /\j O Tvpe of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 1it°8 TVQe of offense Where When bi&,(,)Ia/ 03l77-(10 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 STAT"ERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW— You IT— You must apply for an individual Department of Criminal Investigation Report (form available upon request) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) cleM idrlvb dg 09/2010 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number —7f z? !KY /'? Z . I understand that if I falsely 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 tim#1 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 STATE OF IOWA ) COUNTY OF JOHNSON ) ubscribed and swom to before me by A ► �Q P 11 0 S YVl-LLVI_ . On this I ' " day of IZ ,�'� m� KELLIE K. TUTTLE l� I g X commissl0n Number 221sis Notary Public in and for the State of Iowa --- —T --/ 1 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). Si�/ IGYi gyn ture of� Polic ief or or deh signee O L/�i1./ 2�t -! §gnatttre of City Clerk or designee / 9. .201a- Date 2o%ZDate Date After Police Chief and City Clerk have approved authorized taxi driver names will be placed on the city website at icgov.org. Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update daMwdaiwadeaaaaz IQn 09/2010 R Iowa Department of Transportation Office of Driver Services (Toll Free) OW -532-1121 PO Box 9204, Des Moines, IA 503DB-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/5/2012 DL/ID #: 782yy1942 (IA) Customer #: 3963874 Name: Osman, Allaeldin M Class: D ID Status: VAL Address: 2441 WHISPERING Audit #: 5726504 DL Status: VAL 11/14/2008 MEADOW DR Issue Date: 01/05/2012 CDL Status: None City/State: IOWA CITY, IA 522406807 Expiration Date: 04/18/2013 CDL Cert Status: None 06/12/2009 06/25/2009 Endorsements: 3 CDL Med Status: None Mailing Address: 2441 WHISPERING Restrictions: NONE Restriction None MEADOW DR Date of Birth: 4/18/1964 Supplement: Mailing City/State: IOWA CITY, IA 522406807 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County 3UR 01/12/2004 04/07/2004 ,A20 Deferred Judgment OWI 57 IIA 04/25/2008 06/11/2008 S92 Speed 52 '.IA 11/14/2008 11/25/2008 M14 Fail to Obey Traffic Sign/Signal 52 IA 12/13/2008 03/11/2009 M14 Fail to Obey Traffic Sign/Signal 52 "IA 06/12/2009 06/25/2009 D72 Fail to Have Vehicle Under Control OH 08/09/2009 11/06/2009 M14 Fail to Obey Traffic Sign/Signal 52 IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence ACD Explanation 7UR 01/12/2004 A98 OWI Test Failure IA Sanctions Type Effective End ACD Explanation Occurrence 7UR 3UR Revoked 01/31/2004 07/29/2004 A98 OWI Test Failure IA IA Suspended 09/03/2009 12/01/2009 WO1 Habitual Violator IA IA Suspended 12/29/2009 03/27/2010 'W01 Habitual Violator IA IA Name: Osman, Allaeldin M 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: `aE91Clf n`?a. 1/5/2012 cli�r Office of Driver Services Iowa Department of Transportation Name: Osman, Allaeldin M DL/ID: 782yy1942 J an. 11. 2012 11 ; 44AMII • Vdll. a V. LV 12 L: �LfIYI Oiv of Criminal Investigation UI L 61 eIN — UI I el rowel UI Ly I I (O)F IMA '.'. Crlminn].Mstory Record ;1 e . 'ro. Yowl D3v;siouorcriminalrnvasttgatlon Support Operations Auronu„ 1'r Floor 2f$ r,, 1'r Street Des UpfaesrTowa 50319 (OIs) 71X•6066 (515) 725-4090 bar aniowa 06MOM Cheoi on; No. 6200 P. 1/2 Iso. MO r. L DCIAccoontNumber; 0a- Qeapplte4D c) From: Cyr¢ OF IOWA CiTK CTT:C CMKWS 011aCE .�/ 11LR rra�s tTGTON ,9TRSL4T , OWA CITT toWA 52240 )'hone; 379-356—K0lA1 M I &ql ` w q I Male ' O�emale 122 6 -- q I ^ 3 6" Ql z- 1 IWndye>:Ir#jorYnation:Wtfhoutaslgnedrvafve►]1'eMti109lIb,�00teiiilC1'e�(a&4FjdCemptetd.ePflAtn0.tlll9iePyY®CoYrimp)�noE beYalaos4blerperCodoofYbWAjChapter692,2.Nor gl¢tgbrintfnalittstoxyY000rdfnformntlox,a9allowedbyip>rraIwayS obtain 8 watVOY aloheNre liom ffie,auAteei: ni'iiea rnmiaer.' WPO. Any oonduoimTowaotlmin416ralaryLecoLdofiukwahl4ebNlsln� orCrimfnel io DOTmry6oroleAsod as elfow4d EytAW. Waterers Iowa Crimytaal yms$aryRecord( check)Re�rxYts , rociuroealy) Ag of / of a search of tho provided name and dato of bflth ravealed: E3 No Ybwa 6-hnfnal History Record fowd wfthDCI }?� XOVM Criminal Hfstory Record attached, D(21# -715-5-7a DCT Received Time Jan, 6. 2012 2:31PM No..5526 Jan.13. 2012 11:44AM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00715578 NON CONVICTION PAGE 1 OF 1 DATE PRINTED- DCI:00715578 2012/01/13 NAME: OSMAN, AI.LAELDIN MOHAMED DOB SEX RAC HGT WGT EYE HAIR SKN POB 19640418 M B 508 200 PRO BLK YY ADDITIONAL IDENTIFIERS SC R FOR CCH RECORD *ww 01 ARRESTED 20040112 AGENCY: YA0570000 LINN CO SO CHARGE NO- 01 IA STATUTE IA321J-2-2A OWI IST OFFENSE TRK#: 502380801 COURT DISPOSITION AGENCY: IA057015J LINN CO 131ST COURT COUNT NO- 01 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / 1ST OFFENSE COURT CASE ID: 06571 OWCRO54231 CHARGE CLASS: NOV 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 I No.6200 P. 2/2