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Home My WebLink About14-156 Authorization Number I y—/ 5�LQ f 1 (Office Use Only) v mfr®� :VIII lit IM I APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE 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-I 26 1- 356-5040 (319) 356-5497 FAX First Middle Las 1. Name .. t$7.-a `YI yl-7/ � 2. Mailing Address .5 l ✓13ar f tf 5c IC 3. Telephone: Home (3 17) S 2 / 13 ? Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? / i0 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? t-io 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? W-(;) 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) !4 0 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) clerkltaxidrivbadg 03/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license null-ter 4 2-i /4-t=5 7 `1 S . 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) 7 Signature of Applicant =' Date `'J'/G 6/20/zi 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. STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by/u6kaaA 1+ p /4Lcct;rO . On this ,-1-� day of sUAY Notary Public+ln and for the Statb of Iowa —777� � WENDY S.MAY tK i+,i Commission Number 729428 `T My Commission Expires ***** �k k****,t*t(kt**)r * ******** ******************************************************************************************************** :OWk. .L ! CLQ 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). fly Sig ture of `Ii!- Chief or designee Date i 1 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. 27 (.ate k - k 0- 6 -/< Signa of 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 cleri itaxidrivbadgeapp2014.doc 03/2014 ` r ' 11 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: 9/4/2012 DL/ID #: 424AF5395 (IA) Customer#: 5612203 Name: Hamid, Husham Hashim Class: D ID Status: None Mohamed Osman Address: 2530 BARTELT RD APT 1C Audit#: 6262328 DL Status: VAL Issue Date: 08/30/2012 CDL Status: None City/State: IOWA CITY,IA 522462719 Expiration Date: 05/18/2015 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 2530 BARTELT RD APT 1C Restrictions: NONE Restriction None Date of Birth: 5/18/1975 Supplement: Mailing City/State: IOWA CITY,IA 522462719 Sex: M History Information CLEAR DRIVING RECORD Name: Hamid, Husham Hashim Mohamed Osman DL/ID: 424AF5395 Pursuant to Iowa Code §321.10, I, Klm 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: 7N?'''ICIE `�s 9/4/2012 %0/ y ¢:: IOWA i.t, a ,. 4,• •-. I1i��F OfiNENs I owOfficeof Driver a Departme Departof ment Name: Hamid, Husham Hashim Mohamed Osman DL/ID:424AF5395 Jul. 29. 2014 12: 33PM pDiv of Criminal Investigation No 5754 P. 1/2 ■ d V•I C 7• Clint L. 7 i i n1 I t Y e I M1 V l l y V V I I 'a b i t y n 1u. 1 1 V P. L V IYI . � , "/ ,' STATE OF IOWA .s.Yi " ^ qtotilil ` t Criminal History Record Check. TJ� 2 Request Form! • t.,.ni,:ra3, f l 2V-ST ' DClAccount Number: /`"'a F (lfepplleabie) • To: Iowa Division of Criminal Investigation • ' From: City of Xowa City Support Operations Bureau,1"Floor City Clerk's Office • 215 F.71n Street 410 E.Washington Sheet . Sees Moines,Iowa 50319 (515)12S-6066 Iowa City, IA 62240 (515)725-6000 Fax Phone: 319.356-5041 • Fav: 319-356-5497 • • I am requesting an Iowa Criminal Histol3'Record Check on: Dant Name(mandatory) . 16irst Name(mandatary) Middle Name(recommended) • get y to/ (4/74.94a 6 Date of Birth(malydalotlq Gender Mandatory) Social Security Number(recommended) ' . aill l/7775- P:IMaIe ®Female • 4I" 7Z lit 770 WetiverInformation;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 by lair,always obtain a waiver signature front the subject of the request. Waiver Release:if hcrcbygl vo perinbslon for ilia above requesting official to conduct an town crhnlnoI Idaloq'record check with theDivision of 01111410 Iowa:;gallon(DC1). Any criminal history data warning me diet Is maintained by the DCimay be released nc allowed by law. • Waiver Signature; 4 / ire-G,,7A..J le .7 c,tJ. , Criminal HistoryRecord Check//Results As of 7 .q"/9 ,a search of the provided name and date of birth revealed: r, 0 No Iowa Criminal History Record found with ACI _ Iowa Criminal History Record attached,DCI if [h/5o ! • DCI initials fr.v 'i Received .1rne?5Ju1 .25.152014 2:49PM No. 56201 Jul. 29. 2014 12:33PM Div of Criminal Investigation No. 5754 P. 2/2 �. IOWA CRIMINAL HISTORY DCI 00961507 NON CONVICTION PAGE 1 OF 1 DATE PRINTED- 2014/07/29 DCI:00961507 NAME: HAMID,HUSHAM HASHXM MOHAMED DOE SEX RAC HGT WGT EYE . HAIR SKN POB 19750518 M U 511 210 BRO BLK MBR YY ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD raw 01 ARRESTED 20120725 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA708.2A(2) (B) DOMESTIC ABUSE ASSAULT CAUSE BODILY INJURY/MENTL ILLNSS TRIO: 1A00E$Y01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA708.2A(2) (B) DOMESTIC ABUSE ASSAULT CAUSE BODILY INJURY/MENTL ILLNSS(SRMS COURT CASE ID: 06521 SRCR098829 CHARGE CLASS: NON CONVICTION TRK#: 1AOOESY01 RESTITUTION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20121119 PROBATION 11 20121119 UNSUPERVISED PROBATION, INFORMAL PROBATION REVIEW 06/01/13 DISCHARGED FROM 20130903 DEFERRED JUDGEMENT AN ARREST WITHOUT DXSPOSTTION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OP 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 IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION dj)