Get PA SP 4-164 2013

PENNSYLVANIA STATE POLICE SP 4-164 2-2013 REQUEST FOR CRIMINAL RECORD CHECK This form is to be completed in ink by the requester information will be mailed to the requester only. If this form is not legible or not properly completed it will be returned unprocessed to the requester. A response may take four weeks or longer. FOR CENTRAL REPOSITORY USE ONLY CONTROL NUMBER TRY OUR WEBSITE FOR A QUICKER RESPONSE AFTER COMPLETION MAIL TO https //epatch. state. pa*us NAME/ REQUESTER CENTRAL REPOSITORY 164 1800 ELMERTON AVENUE HARRISBURG PA 17110-9758 ADDRESS 1-888-QUERYPA 1-888-783-7972 DO NOT SEND CASH OR PERSONAL CHECK CITY/STATE/ ZIP CODE CHECK ONE BLOCK INDIVIDUAL/NONCRIMINAL JUSTICE AGENCY ENCLOSE A CERTIFIED CHECK/MONEY ORDER IN THE AMOUNT OF 10. 00 PAYABLE TO COMMONWEALTH OF PENNSYLVANIA THE FEE IS NONREFUNDABLE NOTARIZED INDIVIDUAL/NONCRIMINAL JUSTICE AGENCY ENCLOSE A CERTIFIED CHECK/MONEY ORDER IN THE AMOUNT OF 15. 00 PAYABLE TO CONTACT TELEPHONE NUMBER INCLUDING AREA CODE - FEE EXEMPT-NONCRIMINAL JUSTICE AGENCY NO FEE NAME/SUBJECT OF RECORD CHECK FIRST MAIDEN NAME AND/OR ALIASES MIDDLE LAST SOCIAL SECURITY NUMBER DATE OF BIRTH MM/DD/YYYY SEX RACE The Pennsylvania State Police response will be based on the comparison of the data provided by the requester against the information contained in the files of the Pennsylvania State Police Central Repository only FEES FOR REQUESTS - 10. 00. NOTARIZED FEE REQUESTS - 15. 00. MAKE ALL MONEY ORDERS PAYABLE TO COMMONWEALTH OF PENNSYLVANIA CHECK BOX THAT MOST APPLIES TO THE PURPOSE OF THIS REQUEST REASON FOR REQUEST INTERNATIONAL ADOPTION - INTERNATIONAL ADOPTION MUST BE NOTARIZED AND MAILED IN* 15. 00 FOR REQUEST ADOPTION DOMESTIC EMPLOYMENT/SCREENING PASSPORT ATTORNEY FOSTER CARE PRIVATE INVESTIGATIONS BANKING HEALTHCARE SOCIAL SERVICES BAR ASSOCIATION HOUSING TENANT CHECK CHURCH INSURANCE LICENSE VISA CHILD CARE MENTAL HEALTH VOLUNTEER AMBULANCE/FIREFIGHTER EDUCATION NURSE AID TRAINING VOLUNTEER ELDER CARE OTHER EMERGENCY MANAGEMENT ACCESS REVIEW - NOT FOR EMPLOYMENT PURPOSES* MUST BE MAILED INTO THE CENTRAL REPOSITORY WITH A COPY OF A VALID GOVERNMENT ISSUED PHOTO ID SEE TERMS CONDITIONS AVAILABLE ONLY TO SUBJECT OF RECORD OR LEGAL REPRESENTATIVE WITH LEGAL AFFIDAVIT AND REQUIRED COPY OF GOVERNMENT PHOTO ID ATTACHED FOR THE PURPOSE OF REVIEWING YOUR CRIMINAL HISTORY. WARNING 18 Pa*C. S* 4904 b UNDER PENALTY OF LAW - MISIDENTIFICATION OR FALSE STATEMENTS OF IDENTITY TO OBTAIN CRIMINAL HISTORY INFORMATION OF ANOTHER IS PUNISHABLE AS AUTHORIZED BY LAW* Homeland Security is Everyone s Responsibility - Pennsylvania Terrorism Tip Line 1-888-292-1919. If this form is not legible or not properly completed it will be returned unprocessed to the requester. A response may take four weeks or longer. FOR CENTRAL REPOSITORY USE ONLY CONTROL NUMBER TRY OUR WEBSITE FOR A QUICKER RESPONSE AFTER COMPLETION MAIL TO https //epatch. A response may take four weeks or longer. FOR CENTRAL REPOSITORY USE ONLY CONTROL NUMBER TRY OUR WEBSITE FOR A QUICKER RESPONSE AFTER COMPLETION MAIL TO https //epatch. state. pa*us NAME/ REQUESTER CENTRAL REPOSITORY 164 1800 ELMERTON AVENUE HARRISBURG PA 17110-9758 ADDRESS 1-888-QUERYPA 1-888-783-7972 DO NOT SEND CASH OR PERSONAL CHECK CITY/STATE/ ZIP CODE CHECK ONE BLOCK INDIVIDUAL/NONCRIMINAL JUSTICE AGENCY ENCLOSE A CERTIFIED CHECK/MONEY ORDER IN THE AMOUNT OF 10. .