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Home My WebLink About13-199 Authorization Number / ) (i 1 (Office Use Only) aniZr4Irrikait ft. imp au gar 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 (;31,91-15-6---irk- /A- (319) 356-5497 FAX First Middle Last 1. Name �}(4m MoknJ u4\eJ OSvvt12M E nkPj 2. Mailing Address / 4 S4 Avg ) 10 w'-0.. 1 _1A 5g2 3. Telephone: Homed/7) 3 D— 4(9_0(1f Other: 13 (9)14 ( - 3 t÷-1- (c_1;) 4. Prior experience in transpor)ation of passengers: 06 K ! - sea- ( e' 1 —ho - aATIao LAS ckate.f cv� (Lrk i c_ DTI/Vi e_ cip a 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or el Type of offense Where C 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? 0 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? tv 0 Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N o 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) NI O 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) derk/taxidrivbadg 03/2013 I hereby certify that I have issd to e by the Iowa Department of Transportation a valid Chauffeur's license number .S sa AEI -4-0 1 I c b L . 1 understand that if I falsely answer any questions in this application, that this application may be denied. I un rstand hat 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 If h 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 �� L_.4 Litt I Date_ / ! °' 3 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by N,t AOL` il.A . O . c. 1, yy, r . On this (st1../\._ day of _ _tea ---e-A-- S. flNotary Public in andor the—State of Iowa •- C.. ( I �RV Conwasslom , k - 1I 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). -- --/3 Signa r>�of Po c- hief or designee 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. _,-.1_ .--2,-Ly k_ - ..4../L--, V -- -- ?( .3 Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width) and 5 1/2" (height)and prominently displayed to all passengers. ***************...*.**........*..........*.............. ...............................**.............................***................**... Office Use Only Approved application DCI report State certified driving record Website update GerWtaxidrivbadgeapp2Ol D.doc 03/2013 'r Sep. 5. 2013 4: 21PM Div of Criminal Investigation No. 6333 P. 1 Aug. '29. 2013 11 :32AM City Clerk - City of Iowa City No. 31321 P. 2 r • • • , • ' , " lm • OyE u..',t , 5 ,A.:. Py ydOE 1 LF ! , , mrnal . • a,1, . Pr;TtlecountNurn6er: ' Qtep$tr '.t"os Xolvtaimioil ofCrtmltnalTtvadtlgAMMOU )A-ami °try ok+ Ala_in • Support Op era/toms Aurouut inVoteoar c_rdtlatGvf9 03•X E 2T5E.91o,9treDa 61p . NARBT;191e17 STREEr • faslv/.91(os,Iowva 60319 S (315)774.6066 tot z1 x ?f4 (5.18)125.6080 Nai ' nova, 319-356-50..1 • ' )31%e 379_ _ .&q7• • rAnire.ua9t(n; unto/Crimiti,!BFo Record eliani on; ' t istMame(mandafrf7 ' F1CaE'.Nazttoolendifdry' MiddleaNamo6etoalmearueu , ci6 MAA1 IY4oho411111 ()Sm. 1 ' Dgt0 o birth maldet9 CTe1UTet mono,) goe itigoola'1 Willa- ruommeno'ed 01- l of 067 *de. • army' am . 69 I-- / .- a -77. 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' • J rTIowa Department of Transportation * s Office of Driver Services (fdI Free)800-532-1121 PO Box 9204,Des Moines,IA 50306-9204 515-244-9124 FAX:515-239-1831 Certified Abstract of Driving Record Inquiry Date: 8/24/2013 DL/ID #: 552AG7019 (IA) Customer#: 5880084 Name: Elobeld, Ayman Class: B ID Status: None Mohammed Osman Address: 1456 ABER AVE Audit#: 7233651 DL Status: VAL Issue Date: 08/13/2013 CDL Status: VAL City/State: IOWA CIN,IA Expiration 07/10/2016 CDL Cert Non-Excepted 522464700 Date: Status: Interstate Endorsements: PS CDL Med Certified Status: Mailing Address: 1456 ABER AVE Restrictions: Corrective Lenses Restriction None Date of Birth: 7/10/1967 Supplement: Mailing City/State: IOWA CITY,IA Sex: M 522464700 CDL Medical Examiner's Certificate Certificate Specifics Explanations Medical Examiner First Name Sanenaz Medical Examiner Last Name •Jabbari _ Medical Examiner License Number 139685 _....,_.__.... �... Medical ExaminerJurisdiction °IA _ _ y Medical Examiner Phone ](319)339-3921 Medical Certificate Restriction 1 _ _ Wearing corrective lenses Medical Certificate Issued Date :05/31/2012 Medical Certificate Expiration Date '05/31/2014 Date Added to CDLIS Driving Record 08/13/2013 • History Information CLEAR DRIVING RECORD Name: Elobeid,Ayman Mohammed Osman DL/ID: 552AG7019 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: yy4 Pt.�' IOWA a't sS1D. O. T.•Wa ',el A 8/24/2013 Office of Driver Services Iowa Department of Transportation Name: Elobeid,Ayman Mohammed Osman DL/ID: 552AG7019