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Home My WebLink About12-167CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX i11111111ZIFida 2. Mailing 3. Teleph 4. Prior e; Authorization Number /off' — Ae (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) �I i� OiQi�i'i0 may(_ �icSa�n i4 41 taana4l2. iX e�) m 7tv_ Sa„� T•r� 'L '"44 rvvrli non its n?oa,i 4;?4l,1 , jk av�7jL"u0 ( 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense W b654 C t7 16,ai 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years?Iflo Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? /yy 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) 41/, 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) derl,A aiddvbadg 06/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 252 CC ZS 33 . I understand that if I falsely answer any questions in this application, that this o 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 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 S/ ) 6/Z c Z STATE OF IOWA ) COUNTYOFJOHNSON ) bscribed and sworn to before me by I 1 IQUS+a:&- 001�C_+` On this day of 0 i 2 j� J4� KELLIE K. TUTTLE ° Y Commission Number 22181 otaryPublic in and for the State of Iowa Y ow **+*****R*****kk*Rti#R#R4Rkk444RlRRRR4#;****#*R*********k*RR#**k**RRR4i4RR4444R444RR4R44!ll;RR#4R#R4#!*##kk**#*********kR***4**#R*RRi*4*444ik44# 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). v ggn�njatur of Police Chief or designee / Sign ure of City Clerk or designee /6 -iz Date a -1lo -- / -�— 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. ##R#a#a##kaa#aa#+mR+f44i###R####e#a##*ai+kii#Yi+aii+fiR4lRla#llRaa!'Haa!#+##++aa+#aa#aa+a++ai++i++#R+ffRR44llRfH!#e4a#aaaa##+*RR+R+iRMRRR#4! Office Use Only Approved application DCI report State certified driving record Website update ��bae�10.aoo 06/2012 Iowa Department of Transportation Office of Driver Services (Toll Free) 800-532-1121 PO Box 9204, Des Moines, IA 50306-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 8/9/2012 DL/ID #: 252CC7833 (IA) Name: Omer, Moustafa Eshag Class: B E55 Abakr 77 IA Address: 2409 BARTELT RD APT 1B Audit #: 4729864 77 IA Issue Date: 10/07/2010 City/State: IOWA CITY, IA 522462705 Expiration 01/01/2015 Date: Endorsements: NONE Mailing Address: 2409 BARTELT RD APT 1B Restrictions: NONE Date of Birth: 1/1/1963 Mailing City/State: IOWA CITY, IA 522462705 Sex: M History Information Convictions Customer #: 4289180 ID Status: None DL Status: VAL CDL Status: VAL CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD Explanation County 3UR 11/21/2007 11/29/2007 E55 Driving Without Headlamps or With Park Lamps 77 IA 08/23/2008 08/26/2008 592 Speed 77 IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number IUR 11/22/2006 6252596 IA 10/26/2009 532258 IA Name: Omer, Moustafa Eshag Abakr DL/ID: 252CC7833 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: Name: Omer, Moustafa Eshag Abakr DL/ID: 252CC7833 8/9/2012 IOWA .g�J�- r'•••••• RRIVER= Office of Driver Services Iowa Department of Transportation Name: Omer, Moustafa Eshag Abakr DL/ID: 252CC7833 Aug. 15. 2012 2:21 PM Div of Criminal Investigation No. 9065 P. 4/6 n cvlc J.YJIIYI oily r,ierK — blty 0 Iowa l.lty No. 2696 P. 2 r • its'„ • STAT.8 OF A®wA lqi• yrr' �$']lYp)llrA��.,u,lµ5G01i'�%.4��6'0)it� Q,'g1�Cg� To; Xo1VnblVbIOOfCxlminalTrwestlgar(on Support Opoeallori5 )JurDnu, 1'I.tlronr 213E, 71a street boah(oinos)To1YA So319 (SIS) 725.6066 T (515)125-6090 IUr D/1f G 4 ,Date oi$11•ti1(mondalory) Cheok on; bCI AocountN�rmber: �'0 0 �— j=- Qf'sppltcaDic) Frolnt _CSTY (1F TOWA [TTY CITY CL73M'S OPFICE 410 R WASAThrCs•og 3'+ Rgj 1'ban al 319--356-5041 paxf ._319-356-5[97. _�. f9male ' or,` aTo rYN6veP1s1/orinrtYfo)7. Without F, OgnoA VlorYorIl,om thesubyect of yegneae, a romptot6 ortrArnal history record .mayo tbeleeolablc,perCodeo£Yawh,Chapter692.2—Voreohr bylowi,afw9yobtaa waivoYSIvnamY,.fYnnl » %�Gl)�1/=7'•�B�elY3'GIIlcicb)'q(Yo pon'nIs9IDa4Dcnlonboy rnyealJ@alion(pCp, MyorlmloelJd:lorydaanono6tningmo olticiel to wnduc[ en%yYfl erimfnal hhlotytecoed check W1ti JieDylsipn gpComindi olned 6y IRe DofineybD sefeesed As rIlolYcdbylnlY. As of` a search of tho groyided name and data of bfith roy/ealed., No 16WA Cluninal History kecordfobhd with bGX TOM CriminalTTistoryRecord attachrd,))CT# 0710 1xiinitialsU eceived Time Aug. 9. 2012 3:46PM No. 1142 .�. ,tiScl uinDnly) --i r— w 2012 2:21PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00867634 NON CONVICTION PAGE 1 OF 1 DATE PRINTED- DCI:00867634 2012/08/15 NAME: OMER,MOUSTAFA ADARR DOB SEX RAC HOT .WGT EYE HAIR SKN POB 19630101 M B 507 168 BRO BLK DBR YY ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD ••+ 01 ARRESTED 20090603 AGENCY: IA0770300 DES MOINES PD CHARGE NO- 01 IA STATUTE IA708.2A(2)(A) DOMESTIC ABUSE ASSAULT TRK#: 7BOOBVJ01 COURT DISPOSITION AGENCY: IA077015J POLX CO DIST COURT COUNT NO- 01 IA STATUTE IA723.4(1) DISORDERLY CONDUCT - FIGHTING OR VIOLENT BEHAVIOR COURT CASE ID: 05771 SRCR229351 , CHARGE CLASS: NON CONVICTION TRK#: 7BOOBV.Tol RESTITUTION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT $65 CIVIL PENALTY 20090818 PROBATION 12M 20090810 ASSAULTIVE BEHAVIOR 20090818 CLASS/COMPLY WITH THE NO CONTACT ORDER DISCHARGED FROM JO -PROBATION DISCHARGED 20100322 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 No. 9065 P. 5/6