Get IA 470-5143 2013-2024

Last Name First Name Middle Name Alias if applicable Date of Birth Gender Social Security Number - - Address 1 City State 470-5143 6/13 Maiden Name if applicable Zip Code. Iowa Department of Human Services Record Check Authorization I hereby authorize the Department of Human Services to conduct any or all of the following pursuant to Iowa Code 237A. 5 A check of the Iowa sex offender registry and the sex offender registries of other states. other states. An Iowa criminal history record check with the Division of Criminal Investigation and criminal history databases of other states. Any information maintained by the Iowa DCI will be released as allowed by law including deferred judgments and records of arrest without a disposition greater than 18 months old. A check of Iowa public or civil offense records or those of other states. Signature Date Information Required for Registry and Record Check Please type or print legibly. Iowa Department of Human Services Record Check Authorization I hereby authorize the Department of Human Services to conduct any or all of the following pursuant to Iowa Code 237A. 5 A check of the Iowa sex offender registry and the sex offender registries of other states. other states. 5 A check of the Iowa sex offender registry and the sex offender registries of other states. other states. An Iowa criminal history record check with the Division of Criminal Investigation and criminal history databases of other states. An Iowa criminal history record check with the Division of Criminal Investigation and criminal history databases of other states. Any information maintained by the Iowa DCI will be released as allowed by law including deferred judgments and records of arrest without a disposition greater than 18 months old. Any information maintained by the Iowa DCI will be released as allowed by law including deferred judgments and records of arrest without a disposition greater than 18 months old. A check of Iowa public or civil offense records or those of other states. Signature Date Information Required for Registry and Record Check Please type or print legibly. Iowa Department of Human Services Record Check Authorization I hereby authorize the Department of Human Services to conduct any or all of the following pursuant to Iowa Code 237A. 5 A check of the Iowa sex offender registry and the sex offender registries of other states. other states. An Iowa criminal history record check with the Division of Criminal Investigation and criminal history databases of other states. 5 A check of the Iowa sex offender registry and the sex offender registries of other states. other states. An Iowa criminal history record check with the Division of Criminal Investigation and criminal history databases of other states. Any information maintained by the Iowa DCI will be released as allowed by law including deferred judgments and records of arrest without a disposition greater than 18 months old. An Iowa criminal history record check with the Division of Criminal Investigation and criminal history databases of other states. Any information maintained by the Iowa DCI will be released as allowed by law including deferred judgments and records of arrest without a disposition greater than 18 months old. A check of Iowa public or civil offense records or those of other states. Signature Date Information Required for Registry and Record Check Please type or print legibly. .