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FBI CJIS NAME SEARCH REQUEST FORM Please complete the form below to request a FBI name check. Please be advised that an individual s fingerprints must be rejected twice for image quality prior to requesting a FBI name check. ORI of State/Federal/Regulatory Agency Your Agency s Point of Contact POC for the Response Phone Number of POC FAX Number of POC Address of Requesting Agency Please FAX or mail my response to this request. SUBJECT OF NAME CHECK Transaction Control Number TCN of Subject s Fingerprint Submission Name Alias Date of Birth Place of Birth Sex Race Height Eyes Hair Social Security Number Miscellaneous Number State Identification Number OCA Please note that highlighted fields are required for name check searches. Be sure to include the TCN from both rejected transactions. FBI CJIS Division ATTN Name Check Request 1000 Custer Hollow Road Clarksburg WV 26306 FAX 304-625-5102. ORI of State/Federal/Regulatory Agency Your Agency s Point of Contact POC for the Response Phone Number of POC FAX Number of POC Address of Requesting Agency Please FAX or mail my response to this request. SUBJECT OF NAME CHECK Transaction Control Number TCN of Subject s Fingerprint Submission Name Alias Date of Birth Place of Birth Sex Race Height Eyes Hair Social Security Number Miscellaneous Number State Identification Number OCA Please note that highlighted fields are required for name check searches. SUBJECT OF NAME CHECK Transaction Control Number TCN of Subject s Fingerprint Submission Name Alias Date of Birth Place of Birth Sex Race Height Eyes Hair Social Security Number Miscellaneous Number State Identification Number OCA Please note that highlighted fields are required for name check searches. Be sure to include the TCN from both rejected transactions. FBI CJIS Division ATTN Name Check Request 1000 Custer Hollow Road Clarksburg WV 26306 FAX 304-625-5102. ORI of State/Federal/Regulatory Agency Your Agency s Point of Contact POC for the Response Phone Number of POC FAX Number of POC Address of Requesting Agency Please FAX or mail my response to this request. SUBJECT OF NAME CHECK Transaction Control Number TCN of Subject s Fingerprint Submission Name Alias Date of Birth Place of Birth Sex Race Height Eyes Hair Social Security Number Miscellaneous Number State Identification Number OCA Please note that highlighted fields are required for name check searches. Be sure to include the TCN from both rejected transactions. FBI CJIS Division ATTN Name Check Request 1000 Custer Hollow Road Clarksburg WV 26306 FAX 304-625-5102.

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