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Home My WebLink About12-127I I r -4 CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (319) 356-5040 (3 19) 356-5497 FAX 1. Name First � 1 2. Mailing Address 2'4 25 Authorization Number I o\- - Q 2 (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) Middleok4�� Last nSwtU 3. Telephone: Home 2G Z o Other: 4. Prior experience in transportation of passengers: 3 Y e cw 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When U 6. Have you been n convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? N D Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? N D Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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) 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) 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) derkAmdrivbadg OW2010 `✓61011 Y I hereb ,c�erti tat I hayl ed to me by the Iowa Department of Transportation a valid Chauffeur's license number 2 Z G I � . 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 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 t�Sv� .� �► Date #####1f#h##H*HY*f 1111**itf**f*iHH+******HM4######HHfH#'Ff#fM#H*ff*1**++1HHH1f lf'!f YH+Itff+tHtt*t#**RHHHHH#M#lfHfHf+f f ift1H STATE OF IOWA ) COUNTY OF JOHNSON ) Subs ed and sworn to before me by f i� On this day of 2C)--2_ J%IAIo KELLIE K. TUTTLE �"Q--C--� I�. I u i \ lY I� ®, Commission Number 221e19 Notary Public in and for the State of Iowa o ****f*H}k**##}}Hlffff}#fRfff**HfflR*k**kf***kk***kM#}!f}llffflffff*f*****k**H#*##f}11111tf1llff***k*****k**k#**R#k}}Hf}tftiif*tkfkk*fkltfif I 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). Signatur6 of Police Chief or de1'/ign--ee Date aAni 7- Signahwe of City Clerk or designee Date NOT VALID UNTIL Police Chief and City Clerk have approved and authorized taxi driver names placed on the city website at icgov.org. Taxi cab businesses are required to provide Driver Identification cards. Hfl1111!HHH#####H+#f4H####fHH11fHfHlflfHf+kf#+H+H+H+#f 11HH#Hff*tf1H#}#fH+#'!fi#f 11fHfH#H#HHf##*f!*!#tfH1f#4#4!11!!! lffH Office Use Only Approved application DCI report State certified driving record Website update deMJ id vbadWaM2010do 09QM9 o61zo 11— Iowa Department of Transportation Office of Driver Services (roll Free) 800-532-11211 PO Box 9204, Des Moines, lA 5030-9204 515-244-9124 FAX: 515-239-1837 Inquiry Date: 7/13/2012 Name: Osman, Adil Mohy Eldin Address: 2425 BARTELT RD APT 2D City/State: IOWA CITY, IA 522462709 Mailing Address: 2425 BARTELT RD APT 2D Mailing City/State: IOWA CITY, IA 522462709 Convictions Certified Abstract of Driving Record DL/ID #: 249AD2618 (IA) Class: D Audit #: 5577987 Issue Date: 10/18/2011 Expiration Date: 10/26/2015 Endorsements: 3 Restrictions: NONE Date of Birth: 10/26/1969 Sex: M History Information Customer #: 5410029 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Speed Citation Date Conviction Date ACD Explanation County Jun 10/14/2009 11/06/2009 M14 Fall to Obey Traffic Sign/Signal 52 IA 07/27/2010 _ _ _ _ 10/01_/2010 _ S92 Speed 52 IA 10/29/2011 01/30/2012 M14 Fail to Obey Traffic Sign/Signal 52 IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 05/01/2009 505835 'IA Name: Osman, Adil Mohy Eldin DL/ID: 249AD2618 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: '•?'/,p'4, 7/13/2012 IOWAr ). O. T. T.:, Wi . ....... S Office of Driver Services Iowa Department of Transportation Name: Osman, Adil Mohy Eldin DL/ID: 249AD2618 Mar. 9. 2012 11:51AM Div of Criminal Investigation mar. :). 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