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Applicant And Personal Identification Card Form. This is a Michigan form and can be use in Blue Sky Secretary Of State.
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Tags: Applicant And Personal Identification Card, RI8, Michigan Secretary Of State, Blue Sky
1. NAME (LAST, FIRST, MIDDLE)
A
2. DATE OF BIRTH
3. RACE
MSP USE ONLY
4. SEX
Scanned
Sorted
5. IMPRESSIONS TAKEN BY
B
6. BADGE NO.
8. REVIEWED BY
7. DATE PRINTED
9. AGENCY
10. SIGNATURE OF PERSON PRINTED (IN OWN WRITING)
11. ADDRESS
12. CITY
13. STATE
14. ZIP CODE
12a. COUNTY
C
1. R. THUMB
2. R. INDEX
3. R. MIDDLE
4. R. RING
5. R. LITTLE
6. L. THUMB
7. L. INDEX
8. L. MIDDLE
9. L. RING
10. L. LITTLE
LEFT FOUR FINGERS TAKEN SIMULTANEOUSLY
L. THUMB
R. THUMB
RIGHT FOUR FINGERS TAKEN SIMULTANEOUSLY
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COMPLETE SECTIONS D THRU F WITH TYPEWRITER ONLY
''DO NOT FOLD FINGERPRINT CARD''
16. DATE OF BIRTH
15. NAME OF APPLICANT (LAST, FIRST, MIDDLE)
17. RACE
18. SEX
19. HT.
20. WT.
21. HAIR
22. EYES
50. SID NO.
23. DRIVER LIC. NO. (STATE)
24. SOCIAL SECURITY NUMBER*
D
25. STATE OR COUNTY 26. MARKS, SCARS, AMPS, TATTOOS, ETC.
OF BIRTH
28. APPLICANT
27. ADDITIONAL NAMES (LAST, FIRST, MIDDLE)
FOR:
NAME CHANGE (MCL 711.1)
LIQUOR LICENSE (R 436.1113 & 436.1115)
PERSONAL USE (MCL 28.271)
ADOPTION (MCL 28.271)
CARRY CONCEALED WEAPON (MCL 28.426)
CHILD PROTECTION VOL. (PL102-120)
STATE BAR (MCL 600.949)
CCW RENEWAL, INDICATE LAST ISSUED CCW#
VISA/IMMIGRATION (MCL 28.271)
MI SCHOOL (MCL 380.1230)
RACING COMMISSION (MCL 431.41)
CRIMINAL JUSTICE/LAW ENFORCEMENT (MCL 28.221)
INSURANCE (MCL 500.249 a)
DEBT MANAGEMENT (MCL 451.416)
E
CHILD PROTECTION (PL104-120)
FAMILY INDEPENDENCE AGENCY EMPLOYMENT, DEPT. OF (DSS POLICY)
SET-A-SIDE CONVICTION (MCL 780.621)
SECURITIES (MCL 451.602)
OTHER (1935 PA 59) (specify)
SEARCH REQUIREMENT
Check the criminal File(s) that must be searched for the applicant reason selected. Fees will be charged according to
this selection. If there is no selection, only the state file will be searched.
FBI & State
State Only
FBI Only
WAIVER: I understand the personal information and fingerprints provided on this form are used to conduct a search for prior
criminal records. I hereby authorize release of my criminal information to the person or agency named below.
Signature
29. SEND
F
Date
COMPLETE THIS BOX TO ENSURE CORRECT MAILING OF RESPONSE
Requestor ID #:
RESPONSE TO:
NAME/AGENCY
ADDRESS
CITY
G
STATE
RI-008
(5-2003)
ZIP CODE
APPLICANT AND PERSONAL
IDENTIFICATION CARD
MICHIGAN STATE POLICE
Criminal Justice Information Center
General Office Building, 7150 Harris Drive, Lansing, MI 48913
* Social Security Number is confidential. Disclosure of confidential information is protected by the Federal Privacy Act.
AUTHORITY: 1935 PA 59 / COMPLIANCE: Voluntary.
IMPORTANT: INFORMATION PROVIDED ON THIS FORM MAY BE COMPUTERIZED IN STATE FILES.
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