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Home My WebLink About14-042 • • Authorization Number l — 02 , 1 (Office Use Only) 1 � % 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)ICX e.I 1 , Middle Last �s rn a 1) 1. Name / 1 Gt1E 2. Mailing Address ,,` 6 ,4,i/5 f"Oh c 1 G4-41 64-1 IA 5221-40 3. Telephone: Home (3 let) 3 30 - Other: (31q) 930 — ) 200 4. Prior experience in transportation of passengers: Awe_ &e#hd ri't/i its 7 4x 1epi b /vi �owa 61-1 4t� a rOtthci i �iP C - 2066 . U 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /V0 Type of offense Where When 6. Have you b en convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? NQ Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? ND Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ./P� Type of offense Where When e u `( 4!3/2coq tA5 pr.. MJa 2oIo 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) WC) 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) derkltaxidrivbadg 03/2013 • I hereby certify_that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 1 e5.7- Y t tjtc . . 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 -nd all records and documents relating to this application, and I further agree that, if a license is granted, to comply at all tim:• 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 ofApplican , __ Date,2/27//0 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by ,A)lc:,n f j , 4-1, fill . Y. 5 a.tQ /n . On this a 1 day of ,� s N APER , Commission Number 729428 i��l_ . • My Commission Expires Notary Public in a for the State of lovij I —22j—j �( 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). / ___----- ! .2/2 //7 ature o Police Chief or designee D to 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. 21p/ �i-.7 �/a-1 )JU Signae 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 clerkJaxidrivbadgeapp2010.doc 03/2013 Feb 25, 2014 9:45AM ,Div of Criminal Invest igatios, MI No. 0314 DP. L1/2 I U V, L I. L U17 L• L J11.1 fUltelkilt) 11PI . 1 STATIE ®]F][®WA ,`�"'' . \� IY� P, istlf: %1 Crd00 haat]History'Record Cheek ' ?• } ; lf�eQJ1lIIlt �G Form ?`ry �t•- rI+yry °, DCI AccountNumber: goal—P (ft applicable) To: Iowa Division of Criminal Investigation From: City of Xowa City • Support Operations Bureau,1°t FloorCity Cletlt's Wilco • 215 E.71t'Sfreet 410 L.Washington Street Des Moines,Iowa 50319 (515)12S-6066 Iowa City, IA 62$40 (515)725-6050 Fax Phone; 319.356-5041 • raxt 319-356-5497 • I mn requesting anloWa CS iminnIliistoryRecord Cheek on: Last Noma(mandatory) First Name(mndatory Middle Name(aeammeoded) �.-5MO\v\ RN e\al\A Mohoime.d ybf,(SI"V Date of Birth(mandatory) Gender(meramo°y) Sneial SecunityNamber(recommended) o q//9// 96 ifMale ®Fezuale 09,P6�- 91 `3 S 9 2 Waiver.i'ffolltudiolt:Without a signed waiver from ihe'subject of the request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 692.2.For colnvkto crlminal history record information,as allowed by Jaw,always —-obtain-a-waiver signature,from the subject of the request,--•• • -.-- -- - Waiver Releaser Ihereby give permission for the 111.vo re/Loudly official to conduct an Tom criminalhiuory record cheekwhh ihe Division ofCrimfnel lnocnlgalloa(DCI). Any criminal hdslorydarn cenrcmin1 I that Isznn!n!arfld by 1k;DCI urny b;rckP5cd s TIowcd by law. WaiverSignali-471 —r—: ld2teriae---) All. QAd/ _ r co • J[owa Criminal flistor°v Recori Cheek]Results ,f ,p1,..Rib ... '�; • L/ Lu).•:.1N . Il As of a.—g-5- 7 ,a search of theprovided name and data of birth xovealed; L-;`. , -0 ;•y1 *. —:1 -•. gid: C 0 No Iowa Criminal History Record found with Da 71 r w Y 11.4 Iowa Criminal History Record attached,DCI# 7/557 g • DC'initials i) Received Time—Feb. 21. -2014— 2: 23PNrNo. 01(X3 Feb. 25. 2014 9:45AM Div of Criminal Investigation No. 0314 P. 2/2 IOWA CRIMINAL HISTORY DCI 00715578 NON CONVICTION PAGE 1 OF 1 DATE PRINTED- • 2014/02/25 DCI:00715578 NAME: OSMAN,ALLAELDIN MOHAMED DOB SEX RAC HGT WGT EYE HAIR SKN FOB 19640418 M B 508 200 BRO BLK YY • ADDITIONAL IDENTIFIERS SC R FGR CCM RECORD +t• 01 ARRESTED 20040112 AGENCY: IA0570000 LINN CO SO CHARGE NO- 01 IA STATUTE IA321J-2-2A OWI 1ST OFFENSE TRK{t: 502380801 • COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT • COUNT NO- 01 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / 1ST OFFENSE COURT CASE ID: 06571 OWCR054231 CHARGE CLA5S: NON CONVICTION TRK4: 502380801 DRUNK DRIVING SCHOOL SENTENCE DISE' EFF DAT DEFERRED JUDGEMENT lY 20040415 PROBATION 1Y 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 IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION 9-6 , Page 1 of 2 \ ii T SMARTER I SIMPLER I CUSTOMER DRIVEN �JVWW lowadot, O1 Office of Driver: PO Sox 9204 I Des Moines,IA 50! Phone:515-244-9124 G 800-532-1121 I Fax:515-. www-iovi Certified Abstract of Driving Record Inquiry Date: 2/21/2014 DL/ID#: 782yy1942 (IA) Customer#: 3963874 Name: Osman,Allaeldln Class: D ID Status: VAL Mohamed Yousif Address: 26 ANISTON ST Audit#: 7358959 DL Status: VAL Issue Date: 09/19/2013 CDL Status: None City/State: IOWA CITY,IA 522402216 Expiration 04/18/2018 CDL Cert Status: None Date: Endorsements: 3 CDL Med Status: None Mailing Address: 26 ANISTON ST Restrictions: NONE Restriction None Date of Birth: 4/18/1964 Supplement: Mailing City/State: IOWA CITY, IA 522402216 Sex: N History Information Convictions Citation Date Conviction Date ACD Explanation County 01/12/2004 04/07/2004 1A20. ^' ;Deferred Judgment OWI +Linn 12/13/2008 03/11/2009 .:M14 Fail to Obey Traffic Sign/Signal Johnson 06/12/2009 06/25/2009 - . D72 :Fail to Have Vehicle Under Control __ _ 08/09/2009 11/06/2009 M14 -Fail to Obey Traffic Sign/Signal Johnson 03/26/2012 04/20/2012 :592 Speed Jefferson Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence ACD Explanation JUR 01/12/2004 'A98 Oil Test Failure pIA Sanctions Type Effective End ACD Explanation Occurrence JUR Revoked 01/31/2004 __...107/2 ___.._..._._ ,07/29/2004 'A98 OWITestFailure -IA Suspended 09/03/2009 12/01/2009 W01 _Habitual Violator W IA Suspended 12/29/2009 :03/27/2010 WO1- Habitual Violator IA Name: Osman,Allaeldin Mohamed Yousif DL/ID: 782yy1942 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do here 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 offic currently in the custody of said office, and that I have been authorized by the Director of the Iowa Department of Transportal 2/21/2014 Page 1 of 1 Iowa City DL Station Eastdale Mall 1700 S First Avenue Iowa City, IA 52240 Statement Receipt: 32907266 Customer Information Office Information Name: Osman,Allaeldin Mohamed Yousif As Of Date: 2/21/2014 3:01:33 PM Address; 26 ANISTON ST IOWA CITY, IA 522402216 Location: Iowa City DL Station Phone: Fax: Email: Attached Customers Name Osman,Allaeldin Mohamed Yousif Transaction Type Description Amount MISC Finance Transaction-Osman,Allaeldin Mohamed Yousif $5.50 Product Amount Sale of Records-Certified $5.50 Total Due: $5.50 • Payments Payment Method Payor Payor# Number Amount Tendered Cash Osman,Allaeldin Mohamed 3963874 NA $5.50 Yousif Total Tendered: $5.50 Cash Back: $0.00 2/21/2014