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Live Scan Fingerprinting
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Home
Forms
About
Services
Live Scan Fingerprinting
DNA Testing
Drug Testing
Schedule Appointment
Contact Us
Home
Forms
About
Services
Live Scan Fingerprinting
DNA Testing
Drug Testing
Schedule Appointment
Contact Us
Home
Forms
About
Services
Live Scan Fingerprinting
DNA Testing
Drug Testing
Schedule Appointment
Contact Us
CALIFORNIA STATE BAR FINGERPRINTING FORM
Call for fees
A1104
ORI (Code assigned by DOJ)
LICENSE CERT OR PERMIT
Authorized Applicant Type
ATTORNEY LICENSE
Type of License/Certification/Permit OR Working Title (Maximum 30 characters - if assigned by DOJ, use exact title assigned.)
Contributing Agency Information:
THE STATE BAR OF CALIFORNIA
Agency Authorized to Receive Criminal Record Information
22506
Mail code (five-digit code assigned by DOJ)
845 S. FIGUEROA STREET
Street Address or P O. Box
Contact Name (mandatory for all school submissions)
LOS ANGELES
City
CA
State
Zip code
90017
Contact Telephone Number
Applicant Information:
Last Name
First Name
Middle Initial
Suffix
Other Name (AKA or Alias):
Last Name
Middle Initial
First Name
Suffix
Date of Birth
Sex
Male
Female
Driver's License Number
Height
Weight
Eye Color
Hair Color
APPLICANT MUST PAY AT LIVE SCAN SITE:
Agency Billing Number
Place of Birth (State or Country)
Social Security Number
Misc Number
Other Identification Number
Home Address
Street Address or P.O. Box
City
State
Zipcode
Your Number:
OCA Number (Agency Identifying Number / CAL BAR#)
Level of Service:
DOJ
FBI
If re-submission, list original ATI number:(Must provide proof of rejection)
Original ATI Number
Employer (Additional response for agencies specified by statute):
Employer Name
Mail code (five-digit code assigned by DOJ)
LOS ANGELES
City
CA
City
90017
Zip code
Telephone Number (optional)
Live Scan Transaction Completed By:
Name of Operator
Date
Transmitting Agency
LSID
ATI Number
Amount Collected/Billed
SUBMIT
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