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Get Live Scan Form A0522

Ss Set Contributing Agency: Bureau of Security & Investigative Services 06078 Agency authorized to receive criminal history information Mail Code (five digit code assigned by DOJ) P.O. BOX 989002 Street No. Licensing Street or P.O. Box Contact Name (Mandatory for all school submissions) West Sacramento CA 95798-9002 City Zip Code State (916) 322-4000 Contact Telephone No. Name of Applicant: (please print) Last First Alias: MI Driver's License No. Last First Date of Birth:.

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