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Home My WebLink About12-257� r i + Wylaoi�,l CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-18?6 C—aI 356-5040 fYi 1912-"9 (319) 356-5497 FAX 1. Name Authorization Number /ol' - 9.5 (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) Middle A - 2. MailingAddress -� D!i Tri G CYbwvA f_An �T �c�-Jrt C ."�-�.. T ! 17-44 3. Telephone: Home 3 �` �3 L -3 11 • Other: 4. Prior experience in transportation of passengers: >!e c > ! / ca y y 11 -+Ll% y� trl eow. - -i- f - -- - 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? N [� 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?� Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?� TVDe 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) p D 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) clerW Idrivbadg 09/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number ;14X �7 23 n ) - I understand that if I falsely answer any questions in this application, that this ap lication may be denied. understand tand 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) l Signature of Applicant Date Z v 44444444**.**.*********#####*####4#####4##4444444444444444444444444444*444*4444444.,444*444444*444444444444444444*************************#***** STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by ��o\s 1r ��ySMa,�eL, On this �b day of c� ota�ublic in and f r the State of Iowa -1�3(I t *********#*********####*#4**t44#44444**4*****************************#***#*****#*******k***********#*********************#*******************#** 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). Sig ure of PoPChief or designee io-a6-ia Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. lld2rca� &-t/ Signature of City Clerk or designee Taxi cab businesses are required to provide Driver Identification cards. 44444444444444444444444444444**4*444************#****#***4##########44####44####***####*****#####*#****##4##*#444#*44#4#*444#*444#4444444444444* Office Use Only Approved application DCI report State certified driving record Website update derWiaxidriv adgwa 2010.tl 09/2012 CA Iowa Department of Transportation Office of Driver Services Noll Free) SM -532-1121 PO Bax 9204, Des Manes, !A 50306-92114 515-244-9124 FAX:515-239-1837 Inquiry Date: 10/19/2012 Name: Osman, Tagelsir All Elsir Address: 2706 TRIPLE CROWN LN CDL Status: UNIT 8 City/State: IOWA CITY, IA 522407253 Mailing Address: 2706 TRIPLE CROWN LN UNIT 8 Mailing City/State: IOWA CRY, IA 522407253 Convictions Certified Abstract of Driving Record DL/ID #: 467AF3015 (IA) Class: D Audit #: 5179382 Issue Date: 04/26/2011 Expiration Date: 04/06/2016 Endorsements: 3 Restrictions: NONE Date of Birth: 4/6/1982 Sex: M History Information Customer #: 5750783 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD Explanation County JUR 03/11/2011 04/11/2011 1515 Speed IL Name: Osman, Tagelslr All Elsir DL/ID: 467AF3015 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: Osman, Tagelslr All Elsir DL/ID: 467AF3015 '•�T/��y� 10/19/2012 IOWA . r'••••••' gam= Office of Driver Services ORIVER__= Iowa Department of Transportation r Oct. 24. 2012 11; 08AM V". IV. L V; L L .VVI m c Div of Criminal Investigation O11, vl Oln VI\) ul Ivnu Vlly STATEOVIOWA r I Chace a Request Form No. 1163 P. 1/5 k,L,JL I. L 1 b rz are Cf�ei5lata �G — 2.2 Gal 1�alvez'I'nformkiioh: V{(ifhont n szgnod wp,"voY tom I[tesubjeoc 9f the xegneA(•, q cwnple+E6 cFllv[npl. h/sfa ry reauid may iaoe BoYolomble,pBeCodeoET6w/p,ClSpptet6923.1�or o i e'crlminaIhistoxyredoYdinlokmg6foh}a�alCowed�ylpl,p(fwgys Wrs►Yerheleir rpvullgalfon (pCQ, TP -. DfC�bninMl 40Vt'a Q:lCIY11lIhL�lliiIL$@Y'� i�CCOkd' 4x1@Cxtk$@9llLlf�l , 0pGltic* nnlyj. .A.s Of �' o� Ll ` �a, y a search Gf name 4d data of bixlh.ye'VoaZed; - No lbwa Czt> hal l4ntoxyRecord founilwithDC1 - b Xo�vaCzim9hraXX�'tsxoryltecoxdattaohed,bCr�k Received'fime 001. 18. 2012 2'09PM No,5528 DClACOOm Number; ru • - - QPappl�j To. Xolvabzvfsfoll6fCr1nigalxrivasf)ggdah Brom; 011 017 TWA CITY Support Opetatr6n5 )3gYegv, X'f �Coor CxTY CLux's OB17I03K 2181;. 714 nreat - L•TO V. VASHWGTON S're138'i besi4tolnos,Xolwa 5oy19 - 015) 725 6066 TOWA CITY TOWA 52.240 (5I� 723-baea 6px - I I'hondp R19�."il141 Y�� Naxp "119--a 5fi•-5A97 I am Cc uostTn an Iowa Crimfua(flistorY Record Cheok on; Last Name mandemlA ' MirgIMawe mandafo Middle, NAMB ecommeMGed) svyl a v� 1 J9jP/�S)�� 1 b rz are Cf�ei5lata �G — 2.2 Gal 1�alvez'I'nformkiioh: V{(ifhont n szgnod wp,"voY tom I[tesubjeoc 9f the xegneA(•, q cwnple+E6 cFllv[npl. h/sfa ry reauid may iaoe BoYolomble,pBeCodeoET6w/p,ClSpptet6923.1�or o i e'crlminaIhistoxyredoYdinlokmg6foh}a�alCowed�ylpl,p(fwgys Wrs►Yerheleir rpvullgalfon (pCQ, TP -. DfC�bninMl 40Vt'a Q:lCIY11lIhL�lliiIL$@Y'� i�CCOkd' 4x1@Cxtk$@9llLlf�l , 0pGltic* nnlyj. .A.s Of �' o� Ll ` �a, y a search Gf name 4d data of bixlh.ye'VoaZed; - No lbwa Czt> hal l4ntoxyRecord founilwithDC1 - b Xo�vaCzim9hraXX�'tsxoryltecoxdattaohed,bCr�k Received'fime 001. 18. 2012 2'09PM No,5528