SERVICE COVER SHEET AND NCIC INFORMATION FORM NOTICE: THIS INFORMATION IS INTENDED TO BE USED BY LAW ENFORCEMENT TO IDENTIFY THE DEFENDANT FOR ENFORCEMENT OF THE ORDER AND FOR NCIC DATA ENTRY. THIS FORM IS NOT TO BE INCLUDED IN THE PUBLIC RECORD AND SHOULD BE DESTROYED ONCE THE REQUIRED INFORMATION IS ENTERED IN THE NCIC FILE. THIS INFORMATION IS VOLUNTARY ON THE PART OF THE PLAINTIFF. Plaintiff’s Name: Plaintiff Identifiers: Date of Birth Relationship to Defendant: are or have been in a dating relationship reside together or formerly resided together have a child in common Sex: F M vs. Defendant’s Name: Defendant Identifiers: (Please include all available information.) SEX Any other name(s) Defendant has been known by: ____________________________________________ ____________________________________________ Defendant can be found at (give all available addresses): RACE DOB HAIR EYES SOCIAL SECURITY NUMBER DRIVERS LICENSE # DL STATE HT WT DL EXP. DATE Home Address: ________________________________ VEHICLE MAKE VEHICLE MODEL VEHICLE YEAR ___________________________________________ ___________________________________________ Phone number(s): ____________________________ Times Defendant is usually there_________________ __________________________________________ Distinguishing Features (tattoos, scars, locations frequented, etc.): Please describe: ___________________________________________ Place of employment: __________________________ ________________________________________________________ ___________________________________________ ________________________________________________________ ___________________________________________ ________________________________________________________ Phone number(s): ____________________________ ________________________________________________________ Times Defendant is usually there_________________ ________________________________________________________ __________________________________________ Does Defendant wear glasses? Yes No Other Address: ________________________________ ___________________________________________ Does Defendant own or possess any weapons? Yes No ___________________________________________ If so, what kind(s)? ________________________________________ Phone number(s): ____________________________ _______________________________________________________ Times Defendant is usually there_________________ _______________________________________________________ ___________________________________________ _______________________________________________________ 07/01/2012 American LegalNet, Inc. www.FormsWorkFlow.com