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Get CA BCIA 8375 2010-2024

STATE OF CALIFORNIA BCIA 8375 Orig. 03/2010 DEPARTMENT OF JUSTICE PAGE 1 of 1 ANNUAL CUSTODIAN OF RECORDS NOTIFICATION The Custodian of Records COR is the individual s designated by an agency as responsible for the security storage dissemination and destruction of the criminal records furnished to the agency and who serves as the contact for the Department of Justice DOJ for any related matters as specified in Penal Code section 11102. 2. Agency/Organization Information Agency Name AORI Mail Code Address City State Contact Person Title Phone Number Zip Code Custodian of Records Information additional names may be submitted on a separate sheet Custodian Name Date of Birth The individual s listed on this form is/are currently serving in the capacity of Custodian of Records and has/ have been confirmed by the Department of Justice as the Custodian of Records for the agency listed above. Date Signature of Agency Contact Privacy Notice The information on this form is being requested by the State of California Department of Justice DOJ Custodian of Records Program for the purpose of notifying the Department of the individual or individuals currently serving in the capacity of Custodian of Records for an Applicant Agency. The maintenance of the information collected on this form is authorized by Penal Code section 11102. 2 h. All information requested on this form is mandatory. Failure to provide the requested information will result in the DOJ no longer accepting fingerprint transactions from the Applicant Agency. Information provided on this form may be disclosed to other law enforcement or regulatory agencies. Pursuant to Civil Code Section 1798. 30 et seq. individuals have the right with some exceptions to access records containing the personal information about them that are maintained by the agency. The Custodian of Records Program Manager is the agency official responsible for the system of records that maintains the information provided on this form* For more information regarding the location of your records and the categories of any persons who use the information in those records you may contact the Department of Justice Bureau of Criminal Information and Analysis Custodian of Records Program at P. O. Box 903417 Sacramento CA 94203-4170 or via telephone at 916 227-9565. Mail form to California Department of Justice Bureau of Criminal Information and Analysis P. 2. Agency/Organization Information Agency Name AORI Mail Code Address City State Contact Person Title Phone Number Zip Code Custodian of Records Information additional names may be submitted on a separate sheet Custodian Name Date of Birth The individual s listed on this form is/are currently serving in the capacity of Custodian of Records and has/ have been confirmed by the Department of Justice as the Custodian of Records for the agency listed above. Date Signature of Agency Contact Privacy Notice The information on this form is being requested by the State of California Department of Justice DOJ Custodian of Records Program for the purpose of notifying the Department of the individual or individuals currently serving in the capacity of Custodian of Records for an Applicant Agency. .

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