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Home My WebLink About13-227 Authorization Number 14j',;;;t/. 1 (Office Use Only) -:. nazi ftz 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 (319) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name �n,�.cir/sok/ � ,1 �) i' �'�e, a N b 2. Mailing Address 2.‘ '° ‘ gel/4e) e1 f J 3. Telephone: Home $ 47 2,- c, 9 jZ Other: 4. Prior experience in transportation of passengers: • MYNA t �sd* 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or Type of offense Where 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? ;ti Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? ,/" 6 • Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /J 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) clerwtaxidrivbadg 03/2013 F I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 13'S A 'S a--7p . 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 7 isions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant � = Date �% — 2 7- l_? STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by oSaKa,n 1�pLi5, t- csta On this an day of WENDY S.MAYERge2el Notary Public in a for the State of low Cornsileskiii Member Commission Expires 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). Y S nature f Police Chief or designee Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'SACo-tot OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. YI/ —( /a1/13 Signaf City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/2" (width) and 51/2" (height)and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update • derk/axidrivbadgeapp2O10 doc 03/2013 it Sep. 25. 2013 12:24PM1 Div of Criminal Investigation No. 8985 P. 1/1 v vi L g v i L v i -r•J-r'I l v i „ v 1 v 1 n V11.7UILUITUu v i ,Y n u. J/L V I . L/ L • • .icii- Geed?, • STATE OF IOWA ern „,, !%.�iLlki` Crciminal History Record Check t:':;1 2 • � 1611a i i.,. 4`ts4r� Request Form �? :- 4 ,`moi J,�ami • ACT Account Number: V601-� • (ifapplica le) 10: IOWA Division of Criminal Investigation From: City of Iowa City Support Operations Bureau,i"Hoer City Clerk's Office 215 B,7'h Street 410 B.Washington Street Des Moines,Iowa 50319 (SIS)725.6066 Iowa City, IA 52240 ' (515)725-6030 Fax Phone: 319-3564041 Fax: 319-356-5497 I am requesting an ToWa Criminal TTistory Record Check on: a Last Nano (ntwdatory) First Name (mandatory) Middle Name(recommended) Moll/V [4 )9 o sem► e40 )/D140, Da4'e of Firth(mandetaty) Gender(mandatory) Social Security Number(recommended) O ci r o 1 e— ) 9 gf Male OFemale a 6 2) — 02,— gy 4 4' waiver Information:Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable;per Code of Iowa,Chapter 692.2.For complete,criminal history record information,as allowed bylaw,always , obtain a waiver signature from tho subject of the request. • Waiver Release:I hereby ghee permission for the above requesting official to conduct an Iowa criminal history record check with the Dlvirlon of Camino) Investigation Q CI). Any criminal hhtorydela coneemingme that ismahoained. . . e• •o released as allowed by law. /lloser _ — t--ls, 1"6-4V Waiver 5tgnature: � Iowa Criminal History Record Check Results (DCT use only) As of q -,„9.513 3 , a search of the provided name and date of birth revealed: • No Iowa Criminal History Record found with DCI .•. . . . 0 Iowa.Criminal i istory Record attached,�+ DCI# DCI initials CA J Received Timei;Sep,,2,Q;_p2013 4: 34PM No. 8578 Iowa Department of Transportation GEO Office at Driver Services (TOO Free)8DD-532.1121 FU Box 9204,Des Manes, 51]346 924+! 515-2444124 11111110 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 9/18/2013 DL/ID#: 735A)3270 (IA) Customer#: 6136967 Name: Mahgoub,Osman Class: D ID Status: None Yousif Address: 2606 BARTELT RD Audit#: 7353354 DL Status: VAL APT 1D Issue Date: 09/18/2013 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 09/09/2018 CDL Cert Status: None 522462729 Endorsements: 2 CDL Med Status: None Mailing Address: 2606 BARTELT RD Restrictions: NONE Restriction None APT 1D Supplement: Date of Birth: 9/9/1986 Mailing IOWA CITY, IA Sex: M City/State: 522462729 History Information CLEAR DRIVING RECORD Name: Mahgoub,Osman Yousif DL/ID: 735AJ3270 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: 9/18/2013 . IOWA ': 1 it cloripeavy ::D. O. T. Office of Driver Services Iowa Department of Transporation Name: Mahgoub,Osman Yousif DL/ID:7354]3270