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Home My WebLink About12-134Authorization Number /'�_ / 3 T (Office Use Only) �_ ll APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (Police Department review must be made 410 East Washington Street between 8 a.m. to 3 p.m., Monday— Friday.) Iowa City. Iowa 52240-1826 56-504 Fr1 7�1� (319) 356-5497 FAX Firs Middle Last I 1. Name )SQ �_ SGa Pt' /1 V ka 2. Mailing Address P� 0, -4 to ri �42 (b"iI b-1 le- � A , 57-Z-4( 3. Telephone: Home Z 1 q — 3g — S4F Other: 4. Prior experience in transportation of passengers: fiulU i°�aY �Id. ��Laa_ 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 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? A/ Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? N 0 Type of offense Where When 8. Has your drivers license or chauffeurs license been suspended or revoked in the last five years? A10 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 REV EW 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) derkRexidMadg 09MQ0 ob lauIZ I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license ftmber � 3c Q . I understand that if I falsely answer any questions in this application, that thip application may b� de iecT.-1 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 ith 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 �2 STATE OF IOWA ) COUNTY OF JOHNSON 1 Su crib d and s orn to before me by Sp r',,A� ' ra On this 2--Gj- day of °Vi KELLIE K. TUTTLE � t Commission Number221 I� 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). S' na ur of Police Chief or designee SSign2ture of City Clerk or designee `7-j�?4-1Z Date 7 .0?v -- i0L' 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. Office Use Only Approved application DCI report State certified driving record Website update derlvlaxidriv gea p2010.dm 09r2eto 06110IZ Clows Department of Transportation AW Office of Driver Services (roll Free) 800-532-1121 PO Box 9204, Des Moines, IA 50305-9204 515-244-9124 FAX: 515-239-1837 Inquiry Date: 7/13/2012 Name: Khalid, Osama Saeld Address: 1542 DICKENSON LN I City/State: IOWA CITY, IA 522409111 Mailing Address: 1542 DICKENSON LN Mailing City/State: IOWA CITY, IA 522409111 Name: Khalid, Osama Saeld DL/ID: 553AG3581 Certified Abstract of Driving Record DL/ID #: 553AG3581 (IA) Class: C Audit #: 6063602 Issue Date: 06/20/2012 Expiration Date: 01/31/2016 Endorsements: NONE Restrictions: NONE Date of Birth: 1/31/1966 Sex: M History Information CLEAR DRIVING RECORD Customer #: 5882445 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: 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: ••:;T/p� 7/13/2012 r......" Office of Driver Services `\QRIiIER,_= Iowa Department of Transportation Name: Khaild, Osama Saeid DL/ID: 553AG3581 Jul.18. 2012 2:11PM Div of Criminal Investigation r Jul. 13. 2U12 3:15PM City Clerk - City of Iowa City F�^STATE OV IOWA „ r,t1,CriminalRistory Record Check !' IRequest Form 1�'g To: 10 we Dlvision of CrlutIII III Lives trgatlon support Operations Bureau,1'°xloor 215 M 7(r, Street Des Mofnes, Iowa 50319 (515) 725.6066 '(515) 725-6080 Fay I amreauestinsr an Iowa. Criminal MStory Record Check on: No.4384 P. 1/1 No. 2588 P. 2 DCI Account Number: 'i-Dco- —r (if applicable) From: CITY OF IOWA CITY 6TTC Cj'TRx'S OFFICIr 410 Iv. WASH NGTON STREET IOWA CITY IOWA 52240 Phone; 319-356-5041. Fax: 319-356.5497 Last Name(ntandalory) TYrStName(mandatory) MiddlOX3Me recommends G A1I Date ofBirth (nmda(ory) Croider(manda(ory) Social Seeuri Number recommtndcd 01 3111q b16�MaIe ®� emaie 2 G — 9 5- 3 `J I Waiverinforination: therequest,acomplete crlu\inalhistory record maynot be releasable, per Code of Iowa, Chapter 692,2• For � Iq iT nlefe, criminal history record Information, as allowed bylaw, always WafveY.Rdeeae( T huclby givo pwahzion for the above rcqursring Weld (o cohdnctan Iowa crimioni hisleryrecord check whit nhoblldsloh of Comrnal Inves(lga(lon(AG), Any crimineild5lwyda(scunocmingnyr$9tismela(dnodbylhoDrimaybercleasedasallowed bylaw. Waiver Iowaa• Criminal History Record Clteck .Results (ocrose only) As of f asearehofthe provided nameand dareofbirthrevealed: ,-_ • No Iowa CA•lminal Hisfoly Record )Lound with DCI 4. ® Iowa Criminal History Record attached, DCT # ro ACT D... :...J r:_ -7•1..i 10 lrgnln 0.14MA Ki_ UlI