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Gov/suffolkdistrict 631 853-7500 CERTIFIED TRANSCRIPTS / CERTIFICATES OF DISPOSITION DATE OF BIRTH NAME STREET CITY STATE ZIP PHONE LAWS VIOLATED DATE OF VIOLATION DATE OF DISPOSITION DOCKET NUMBER NECESSARY IF A TRAFFIC CASE PRIOR TO JULY 1 1996 REASON FOR TRANSCRIPT e.g. License suspension employment any licensing or permits YOU MUST ATTACH A 5 MONEY ORDER CERTIFIED CHECK OR ATTORNEY S CHECK PAYABLE TO FIRST DISTRICT COURT FOR EACH DOCKET NUMBER. ALSO INCLUDE A SELF-ADDRESSED STAMPED ENVELOPE. MAIL TO SUFFOLK DISTRICT COURT ATTN TRAFFIC/CRIMINAL ROOM 220 TRANSCRIPTS 400 CARLETON AVENUE CENTRAL ISLIP NY 11722 TODAY S DATE TRANSCRIPT REQUESTS ARE COMPLETED IN THE ORDER IN WHICH THEY ARE RECEIVED. ALL REQUESTED INFORMATION MUST BE FILLED IN OR YOUR REQUEST WILL BE RETURNED. SHOULD YOU NEED ANY ADDITIONAL INFORMATION CONTACT CENTRAL RECORDS IN YAPHANK FOR YOUR ARREST RECORD 631 852-6015. STATE OF NEW YORK UNIFIED COURT SYSTEM I SUFFOLK COUNTY DISTRICT COURT 400 Carleton Avenue - Central Islip - New York 11722 nycourts. gov/suffolkdistrict 631 853-7500 CERTIFIED TRANSCRIPTS / CERTIFICATES OF DISPOSITION DATE OF BIRTH NAME STREET CITY STATE ZIP PHONE LAWS VIOLATED DATE OF VIOLATION DATE OF DISPOSITION DOCKET NUMBER NECESSARY IF A TRAFFIC CASE PRIOR TO JULY 1 1996 REASON FOR TRANSCRIPT e*g* License suspension employment any licensing or permits YOU MUST ATTACH A 5 MONEY ORDER CERTIFIED CHECK OR ATTORNEY S CHECK PAYABLE TO FIRST DISTRICT COURT FOR EACH DOCKET NUMBER* ALSO INCLUDE A SELF-ADDRESSED STAMPED ENVELOPE* MAIL TO SUFFOLK DISTRICT COURT ATTN TRAFFIC/CRIMINAL ROOM 220 TRANSCRIPTS 400 CARLETON AVENUE CENTRAL ISLIP NY 11722 TODAY S DATE TRANSCRIPT REQUESTS ARE COMPLETED IN THE ORDER IN WHICH THEY ARE RECEIVED. ALL REQUESTED INFORMATION MUST BE FILLED IN OR YOUR REQUEST WILL BE RETURNED. SHOULD YOU NEED ANY ADDITIONAL INFORMATION CONTACT CENTRAL RECORDS IN YAPHANK FOR YOUR ARREST RECORD 631 852-6015. IF YOU WERE A YOUTHFUL OFFENDER OR YOUR CASE WAS SEALED ADDITIONAL PROCEDURES MUST BE FOLLOWED IF YOU WERE ADJUDICATED AS A YOUTHFUL OFFENDER PLEASE SIGN FORM 1 BEFORE A NOTARY PUBLIC AND RETURN IT ALONG WITH THE FEE AND A SELF-ADDRESSED STAMPED ENVELOPE* IF YOUR CASE WAS SEALED PURSUANT TO CPL 160. 50 AND YOU WANT THE TRANSCRIPT SENT TO YOU COMPLETE FORM 2. IF YOU WANT IT SENT TO SOMEONE ELSE COMPLETE FORM 3. IN ANY CASE THE FORMS MUST BE RETURNED ALONG WITH THE FEE AND A SELF-ADDRESSED STAMPED ENVELOPE* DC-411 12/07 District Court County of Suffolk located at People of the State of New York Youthful Offender Transcript Release -against- Docket Defendant DISTRICT COURT residing at having been adjudicated a YOUTHFUL OFFENDER on hereby request that a transcript of the disposition of my case be released to me or to I understand that the individual or organization named above is not bound by the sealing requirement of the CPL* Date Defendant s signature. On the day of before me personally came known to me or satisfactorily proven to me to be the person described in and who executed the foregoing instrument and acknowledged that he executed the same.