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HomeMy WebLinkAbout18-090CITY F IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319)3S6-SO40 (319)356-5497 FAX Last 1. Name (REQUIRED) _ IDENTIFICATION NO. (� (Office Use Only) F �PIFCkT ON FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) Md" IMxoti 046 86 "required" information will result in denial of the apOication CITY CLERK ©jMq-I First Middle k5tl� M oha„7p C S 2. Address (REQUIRED) 2 S3 C, -scl(4et C F ck 9 f) r�W -A 0%y\ , TO -01A 3. Contact Information (REQUIRED) Email: Cell Phone: QM)SIt_2}ts1 (AII written'communication sent via email) 51 a - a 3 4a. Driver's License expiration date (REQUIRED) 034ti / '),'�"-, b. Taxicab Business Name (REQUIRED) 1C�v1e+r 5. Prior experience in transportation of passengers: 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense What happened to the charge? (Circle one) Where When Al U Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? A! " Tvce 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) A10 (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0412018 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 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). I her certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number G'] issued on ,expiring on ©3I a 12oi t . 1 understand that if falsely answer any questions in this application, that this application may 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 authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of Title , Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date O$ f2y/1 $ STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by aA .Q<j"c.,n on this Z9 day of A....., a I- �'�j Si I have reviewed this application, DCI report, and the State certified driving record of this applicant and hWe determined that there is no information which would indicate that the issuance would be detrimental to the safes healttriv- welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). jyy Expiration dater' s se 1 //tZ L �� tO a � � � m -fir &Q___ p Signata a of Police Chief or designee Date cn v � AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. Signature of City Clerk od esignee \ Date L �J Approved application DCI report State certified driving record Website update Office Use Only Q&kff x1MNW.Dcenaa02oiea�WDOC 04/2018 mug. I), LVIo ):19rm UIV ei brlmindl investigation No.vj)9 Y. 1/2 Fram:Ctey or Iowa Clay Ciark Olfloa 010 3666407 oa/oa,aola 10:54 6600 P.002/002 STATE OF IOWA AOM 1 )l unniinai ftigtory Record Check �4 i" albll ua..11 A' Vl aL l To. Iowa Divlslon of Criminal Investigation Support Operations Bureau, I" Floor 215 E. 7`a Street Des Moines, Iowa 50319 (515) 725-6066 (5I5) 725.60$3 caw am requesting; an T"Iet Alamo Omar, .11 % n DCI Account Number: —qM,2,J-5: Qrapplicable) Prom: City of Iowa Cie City Clerk'a wrice E� 4109. washingioa.i :feet w"• Iowa City, IA 5220—+ v� Phone: 319-3S6-5041 I �• Far, 313-s51ia'49'i m i - No Iowa Criminal Hi.cingy Rr..rnM fn in with DCI S. t ' en ® m Iowa Criminal History Record attached, DCI # i-riii'atiii; ltiasoe tre woutnde� S DO iuitials�/ nate 01 Sarin (5a dLWA I Gender kandeorv) Social Serttrity N��m11er ; "•• _yam ., 63l it� % g s e�1_ --:49 _ II'1 6 Mela ❑Female cen,pieie triminai history record may not be releasable, per Code of Iowa, chapter 692.2. For complete criminal I,Itenry mWd inrormeelo„ 3t .n_ tled i..: ,,... _iv."•'" ob-f in a t�_. from A. a,- / - va . ,., u use %:F,�i 1.' FI VUF tuV OU V1GZt r/i tljd jClt Yl'd 1. tl_/.. ,.... I. Iii .....n.... •.w .. .,,. ,i,�cS1iy11V111 V�ri1• NI)YIIIIIIAI %VAIIVY Ii.I�mnMJVC11[ :utu:•it::::ir.::•::r.-::.::a:,:ny Sitiil iiltLi:'•s:t: f's'::•�ica C:In:lr,:: .f^.-vrr. C1e•i es:e::..1 Y1/� ! , iT.... .. ...L ^! _ r.. 'el •. I ••• n •. .. ____: _sea.`.`>eii!" ease.••• _: __ __il'rt. •"'•E ' w"• Ac of t% i J /(1 o naw...:. �PA,� .:�_� _ - . . .��:. ..-.«v ,.. VM•va vuw lMra.alW. I �• i - No Iowa Criminal Hi.cingy Rr..rnM fn in with DCI S. t ® U Iowa Criminal History Record attached, DCI # DO iuitials�/ `mLrg. i 1. zvio ]:arm viv or Gr!m!.n.&I !nvest!g8T10o No.uJj) P. 2/2 DISCLAIMER ! i}le reepnnee rannniy ....W�io p��niiG Criminai niesna;i /inra, i in lrer inwa iayr mos! juvenile records are confidential. Confidential juvenile court records, If any, cannot be Inl:il/riP.ri,ln fh!.0 remnnnGA, A RinnPd rains -e A!iihnriradon hs nni iif7'iris. ni to nnia.in ►%I,li confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18), LN-•i/'.v - ___ ,C[ ��__ __�/ Ui'u'::. � _ J_ /LI., r4 __�_ _t_ �_/:_ _ _:I_LI_ :_ ..f/_ •/L_ ._r! ._I �_..-_J_,L_,� L /....� ry •./!I/ L •�_..�.i.J_-/W andL�oI • /:_I Vl, t„/J JItO, VIO a1r W01 I G4 VIYJ /VI juvo,"'WJ 11/Oy ails"" 4V/IIIYOI/NO% a%IY Qny �YIIIIdG%/V OI tlii.`i rv:cor 4 ,ii cs,'4Cr tv r.^.yvc'..i ilio rClr^YJC cvf fiu'niitiai ju'✓8iiiie r'eVUl UZ,, if aiiy, nr� di3iiiiO auii iiiu5t ue /iied Nui$uaiia iu luwa mauve section 232.147/181. N O (� OJ ti -1 Ci lD �r rn a M T en rn ARTS Page 1 of 2 C�4•IOWADOT www.iowadotgov SMARTER I SIMPLER I (USTOMER DRIVEN Drfwr & IAentffrcation Setvic" Piz Box 92641 Des Moines, IA 50306-9204 Phone: 515244-91241 Fax 5152331837 Inquiry Date: Customer Name: Address: City/State: Mailing Address: Mailing City/State: Date of Birth: Sex: 8/8/2018 6409705 Certified Abstract of Driving Record DL/ID #: 942AL5605 (IA) CDL Permit Class: None Class: D Osman, Mohamed Sharaf Audit #: 1979583 Mahjoob CDL Permit 2530 BARTELT RD APT Issue Date: 07/19/2017 1D None Restrictions: Expiration 03/11/2022 Date: IOWA CITY, IA Endorsements: Chauffeur 3 522462719 2530 BARTELT RD APT Restrictions: NONE 1D Restriction None IOWA CITY, IA Supplement: 522462719 3/11/1981 M History Information CLEAR DRIVING RECORD Name: Osman, Mohamed Sharaf Mahjoob DL/ID: 942ALS605 (IA) CDL Permit Issue None Date: CDL Permit None Expiration Date: CDL Permit None Endorsements: CDL Permit None Restrictions: ID Status: None DL Status: VAL CDL Status: Nonw, CDL Permit-- ELGco Status: O Services CDL Cert Status"j,.:Aonari CDL Med StatuagCNpne�o -Cm s UI m Pursuant to Iowa Code §321.10, I, Darcy Doty, Driver & Identification Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by Driver & Identification 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: 8�//8/y/22018 A VL Driver & Identification Services Iowa Department of Transportation Name: Osman, Mohamed Sharaf Mahjoob DL/ID: 942AL5605 (IA) http://172.29.254.55/drivers/reports/customerhistorylcertifieddrivingrecord.aspx 8/8/2018