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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
REQUEST FOR LIVE SCAN SERVICE
(Record Review or Foreign Adoption)
Call for fees
ORI (Code assigned by DOJ)
CA0349435
Type of Application (Check One Only)
Record Review
Foreign Adoption
Reason for Application
Contributing Agency Information:
DEPARTMENT OF JUSTICE
Agency Authorized to Receive Criminal Record Information
7041
Mail Code (five-digit code assigned by DOJ)
P.O. BOX 160207
Street Address or P.O. Box
RECORD REVIEW UNIT
Contact Name (mandatory for all school submissions)
SACRAMENTO
City
CA
State
95816-0207
ZIP Code
(916) 227-3835
Contact Telephone Number
Applicant Information:
Last Name
First Name
Middle Initial
Suffix
Other Name (AKA or Alias)
Last Name
First Name
Suffix
Date of Birth
Sex
Male
Female
Driver's License Number
Height
Weight
Eye Color
Hair Color
Misc. Number (Other Identification Number)
Place of Birth (State or Country)
Social Security Number
Telephone Number
Street Address or P.O. Box
City
State
ZIP Code
I have received and read the included Privacy Notice, Privacy Act Statement, and Applicant's Privacy Rights.
Applicant Signature
Date
Level of Service:
DOJ Only:
If re-submission, list original ATI number (Must provide proof of rejection):
Original ATI Number
Foreign Government Embassy: (Mandatory for Foreign Adoption requests pursuant to Penal Code section 11105(c)(12))
Designee -- Do not include Employer: (Optional for individual designated by applicant pursuant to Penal Code section 11124)
Designee or Embassy Name
Street Address or P.O. Box
City
State
Country
ZIP Code
Telephone Number
Live Scan Transaction Completed By:
Live Scan Transaction Completed By:
Date
Transmitting Agency
LSID
ATI Number
Amount Collected/Billed
SUBMIT
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