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Home My WebLink About13-007Authorization Number 13-7 (Office Use Only) APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (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 (319) 356-5040 (3 19) 3S6-5497 FAX First Middle Last 1. Name Alia pf I^Vi M 1 cy;w 3V1 2. Mailing Address 2y Ani.5LYl S� ]nrAjcA c44 -fA 522"(7 3. Telephone: Home 314— 430 — I Zoo Other. 051 61 330 — 9 (v o 4. Prior experience in transportation of passengers: ha /,o 11 w gI dam;'✓,_H6i Ta 'y L CQ P3 .r.v r "1 )leayS ctf TOLkkA G'rq aAAJ .S'LIVVVL(IAA6nd 6 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? IVO 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? Alio Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? A(O Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ')Oe$ Type of offense Where When NabJQA�bl%olak 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) 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) derkeawddma g 09/2012 I hereby certify that uI have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number 7f32 I i 4 7-- . 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 timwith all of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) /T Signature of Applicant t - Date 611114.1l3 STATE OF IOWA ) COUNTYOFJOHNSON ) -/p v� / Su scribed and _sworn to before me by /q (Q/U/ W-� On this ��' ' day of -o/� -TZ1VZC KELLIE K. TUTTLE otary Public in and for the State of Iowa ,TerninivasCP�oa nrnunel myn�hiI-WO Exdres 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). Signa re of Police Chief or designee /6/, .'Jr 43 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. Signature of City Clerk or designee Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update /- /5`-/3 Date dedrtaxidnvbadgeapp2010.d 09/2012 Page 1 of 2 Iowa Department of Transportation Office of Driver Services (Tall Free) 8W-532-1121 PO Box 9204, Des Moines, IA 51]306-92[)4 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/12/2013 DL/ID #: 782yyl942(IA) Customer #: 3963874 Name: Osman, Allaeldin M Class: D ID Status: VAL Address: 26 ANISTON ST Audit #: 6612726 DL Status: VAL S92 Speed Issue Date: 01/12/2013 CDL Status: None City/State: IOWA CITY, IA Expiration 04/18/2013 CDL Cert None IA 522402216 Date: 03/11/2009 Status: Fail to Obey Traffic Sign/Signal_ _ d 52- Endorsements: 3 CDL Med None D72 -M14 'Fall to Have Vehicle Under Control Fall to Obey Traffic Sign/Signal _ OH v 52 fIA_—W� Status: ;04/20/2012 Mailing Address: 26 ANISTON ST Restrictions: NONE Restriction None Operating While Intoxicated Test Refusal/Test Failure Violations Date of Birth: 4/18/1964 Supplement: Occurrence Mailing City/State: IOWA CITY, IA Sex: M JUR 522402216 01/12/2004 !A98 iOWI Test Failure History Information Convictions Citation Date Conviction Date ACD Explanation County IUR Ol/12/2004 04/07/2004 _ .A2U ;Deferred Judgment OWI 57 IA 04/25/2008 (06/31/2008 S92 Speed .52 IA 11/14/2008 11/25/2008 M14 Fail to Obey Traffic Sign/Signal j52 IA 12/13/2008 03/11/2009 M34_ Fail to Obey Traffic Sign/Signal_ _ d 52- IA 06/12/200906/25/2_0_09 08/09/2009 411/06/2009 D72 -M14 'Fall to Have Vehicle Under Control Fall to Obey Traffic Sign/Signal _ OH v 52 fIA_—W� 03/26/2012 ;04/20/2012 592 ,Speed 51 IA , Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence ACD Explanation JUR 01/12/2004 !A98 iOWI Test Failure SIA i Sanctions e Effective End ACD Explanation Occurrence JUR JUR rkevoked X01131/2004-07/29/2004 +A98 .OWI Test Failure IA _ IIA pended 09/03/2009 12/01/2009 WOl -Habitual Violator ._ ----T---......_ IIA fIA pended ... ._ !12/29/2009 03/27/2010 iW01 ;Habitual Violator IIA IA Name: Osman, Allaeldin M DL/ID: 782yy1942 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. 1/12/2013 Jan: 7. 2013 11:05AM Div of Criminal Investigation Jan;, 2. 2013 10:45AM City Clerk - City of Iowa City 0 ��+ r c0nliraalJ lstoryRecoud Cheek Requegt Form Noo. 1040 I UDPP. 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Waivaj.-Y&fol7s1gP10)7: Vlithou!aat�{nerl Watyoraloin thesu6jecsofthe Yerjnest, a romplefe crflainAl fiisfory reeaYd )nnynot DOIrilealub163PueCode GrYWp,ClSnpter6922Yivrco e!a'arinfina(fdataiyreeoYdfriUWL1116a,asalloWddtjIAY;,AIWoys obtarli wniversl na[ureltomEha,suA 6cIt,rx cele u�tJ WlLlY2NkLde(tj'BlihercGygiveperfilcy(dnfdrl)IoeOoYere Ifdgae7c,0ltocondoolunYo,yncdmlnalfilsloryrecaracfierkWiifUAeDN,'slongfCLfminaf rnyosirgmten MI). Any WnIhIMs(ory AM bOnocmrngnto l$, elN01aed6y161)0imey bo[olcesdd 03 eUowed byTeyf. WulveT3'tgnrrt'ure; -_ owa C'S'JiMbffian$ ffistor ' J[�ecar Ch ee C) esytYt� . w011go only) As of a sear�tl6fthoprovid'edname and date oi'birth teveaIed: • ' ' .' ,.' • ia•. -� i �:. VQ El go 16wa Gri,ninalPistoxy Record found. Wit xIDC> . . Yovta GMminallliatoayltecord attached, )MA-1V�C!fl � ra bCCit�I(fais � , ROf P,I VP.I 1"Ime�o,I z'o: 7. 9011 10:45AM No. 8496 Jan.. ]. 2013 11:06AM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCT 00715578 NON CONVICTION PAGE 1 OF 1 DATE PRINTED - 2013/01/07 DCI:0071557B NAME: OSMAN,ALLABLDIN MOHAMBD DOB SEX RAC HGT WGT EYE HAIR SKN POB 19640418 M B 508 200 BRO BLK YY ADDITIONAL IDENTIFIERS SC R FGR CCH RECORD *** 01 ARRESTED 20040112 AGENCY: XAO570000 LYNN CO $O CHARGE NO- 01 IA STATUTE IA321J-2-2A OWI IST OFFENSE TRK#: 502380801 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE XA321J.2(A) OPER VRH WN XNT (OWI) / IST OFFENSE COURT CASE ID: 06S71 OWCROS4231 CHARGE CLASS: NON CONVICTION TRK#: 502300001 DRUNK DRIVING SCHOOL SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 1Y 20040415 PROBATION lY 20040415 DISCHARGED FROM 20041104 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 XS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR XNQUIRY. DIVISION OF CRIMINAL XNVESTYGATXON No.1040 P. 2/2