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Home My WebLink About13-0891. First ^ n��e ` Middle ^�al-� Name e / Last h,,-, 2. Mailing Address 24?00 R6' �r/yPlt go Apt & IA 21,01,vfl C1,4y, TAS -ZZL16 3. Telephone: Home Other. (311% ZoZ —21/� 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 1/0 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? N Tvoe 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) Gerwtmdwbad9 - 03/2013 I " —0q Authorization Number i i' 1 (Office Use Only) r""111 7k cccccrz CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 41 0 East Washington Street between 8 a.m. to 3 p.m., Monday — Friday.) Iowa City. Iowa 52240-1826 �3T9f 356-504 jt}eot-� (319) 356-5497 FAX 1. First ^ n��e ` Middle ^�al-� Name e / Last h,,-, 2. Mailing Address 24?00 R6' �r/yPlt go Apt & IA 21,01,vfl C1,4y, TAS -ZZL16 3. Telephone: Home Other. (311% ZoZ —21/� 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 1/0 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? N Tvoe 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) Gerwtmdwbad9 - 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number _5 U 4G _lave 3 . 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 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 12� Date vf - I," — Z O /? RYY**#*R***R********#+*+##+++#*+#######**R##***RY***#RRR*****#**********t**##**########Y+###*#**##Y*#YY#R*RY*RRR*RRRh*RR4#***R***R************** STATE OF IOWA ) COUNTYOFJOHNSON ) S scribed nd sworn t before me by 0 ►�0 nee r 0sYv, . On this ) '' V` day of TUTTLE Number 221619 otary Public in and for the State of Iowa .oma is 121" KELLIE K. Commission row 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 g `natu of Police Chief or designee �%/r% 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. Sign re of City Clerk or designee '//7- /� Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 51/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update ded tdriwadgeaev2010 doc 03/2013 • h r. 16. 2013 4: 28PM Ao r. 1 I. 2013 10: 51AM -u�euss, �' Q ��, 1 ,Y Cyy Div of Criminal Investigation City Clerk - City of Iowa City Tos Xo1lra.h(sYe10h6fQfM1Aa1.T11vestfg11d6n Support Aparaft6ns Rurouu,l'I NYoor 213, 7'ryS(YOOt bosh?yfnasyXo�ns �u�i9 G'Yx5)72'hbUAO Nave IAmre pestfn aalm'aCrrhvnai.Ri .>Jsstil-emc ,�adte ORO (),M •t& mmsdrlo IgOA Waker.Ir{foMaYMoN., Mhout a s6te ba rAfeasnbTe, perCOdo aPxaWq, eha�ler No. 0382 P. 1/1 No. 3386 P. 2 I . ) 1 Al WS p.'.. :.G ary:'iik'v' r ini\ �vt Ovlee� wady vltom ACxA000t1nt17s5m6er: I "��- ' F peaQpl3rnD o kYams Ctrs' n� rot7A cs¢'s'v' CITY Cr,B llg Onxcz 410 7i_ A'ASWA Ot7'STR= TOLYA CL'I'P 1017&-- 1 AO pholse; 379�9K —50 Al NAx 319-35(.5497 /LA okl-PA 0)706te I - 2 V6, l3 -;Z(*z a eoynprafo obOlalhIsfory teaordruayuot orrYk&XMnt1o11xA9ARQWod VIAvr, n(vays illt�Ye1'Xi'8�8l15i+3YhercByg(va permisyforftCrlhnn6oVeYeyosslfoBro111olpl [O candvoswtYo\ve orlm(nel filalaty[aeeld ohakw(III IhebiS{�lon OP�iminof YnYes'IYQetfod�o0. NlyalmMelll/srosydal¢apdWm(tlgnlofint>rsnelO�le�frtedlyy�thoApTmpy6atefeavcdaaalfolYtdWY�\Y• Aa o; "7`��' l �J .asealthofthoprovUedniirpo, 466Yani'li 14X8yeale CL. ND old foWwSt ))OT Yom 6holnoUfflafoxy Recotdattaahed,i7cQ X7Cliuittals_�!!'( .. r. .. n—n.. r.,u a nn r 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: 4/11/2013 DL/ID #: 564AG3573 (IA) Customer #: 5901101 Name: Osman, Moneer Class: D ID Status: None Mohamed Address: 2420 BARTELT RD APT Audit #: 6532390 DL Status: VAL IA Issue Date: 12/11/2012 CDL Status: None City/State: IOWA CITY, IA Expiration 01/01/2016 CDL Cert None 522462707 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 2420 BARTELT RD APT Restrictions: NONE Restriction None 1A Date of Birth: 1/1/1980 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522462707 History Information CLEAR DRIVING RECORD Name: Osman, Moneer Mohamed DL/ID: 564AG3573 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: •:?'Vrr 4/11/2013 IOWA %oo, U4 alcoremk P ....... = Office of Driver Services Iowa Department of Transportation Name: Osman, Moneer Mohamed DL/ID: 564AG3573