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Get VA SP-167 2009

VEL) NAME INFORMATION TO BE SEARCHED: OTHER (please specify): _______________________________ LAST NAME RACE FIRST NAME SEX DATE OF BIRTH / MIDDLE NAME MAIDEN NAME SOCIAL SECURITY NUMBER / (MM/DD/YYYY) AFFIDAVIT FOR RELEASE OF INFORMATION: I hereby give consent and authorize the Virginia State Police to search the files of the Central Criminal Records Exchange for a criminal history record and report the results of such search to the agent or individual authorized in this document t.

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