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PSP Data Sheet Information Form. This is a Pennsylvania form and can be use in Carbon Local County.
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Tags: PSP Data Sheet Information, Pennsylvania Local County, Carbon
PSP Data Sheet Information
Defendant Information: ______________________________________________________________________
First
Middle
Last
Suffix (Jr, Sr,)
Defendant’s Alias: _________________________________________________________________________
Defendant’s Sex:
Male / Female
Defendant’s Race:
Home Phone: ________________________________
Caucasian / African American / Hispanic / Latino /
Asian American / Pacific Islander / Other _____________________________________
Defendant’s Date of Birth: __________
Month
___________
________
Day
Year (20___)
Age:
_________________________
Defendant’s Address (if known): _____________________________________________________________
City/State/Zip_____________________________________________________________________________
Defendant’s State of Birth: __________________________________________________________________
Defendant’s Skin Tone:
Fair / Light / Medium / Dark / Other ___________________________________
Defendant’s Height (approx.): ______________
Defendant’s Weight (in pounds):____________________
Defendant’s Eye Color: ___________________
Defendant’s Hair Color: __________________________
Defendant’s Scars, Marks, Tattoos: ____________________________________________________________
Defendant’s Social Security Number:__________________________________________________________
FBI Number: _____________________________________________________________________________
Defendant’s Miscellaneous Number:___________________________________________________________
Defendant Spends Time (Bars, Friends, etc.): ______________________________________________________
Defendant’s Operator’s License Number: _______________________________________________________
Defendant’s Operator’s License State: __________ Operator’s License Year: _________________________
Defendant’s Vehicle Registration Number: _____________________________________________________
Defendant’s Vehicle Registration State: ________________________________________________________
Defendant’s Vehicle Registration Year: ________________________________________________________
Defendant’s Vehicle Registration Type: ________________________________________________________
Defendant’s Vehicle Identification Number: ____________________________________________________
Defendant’s Vehicle Year: __________________________________________________________________
Vehicle Model: ___________________________________________________________________________
Defendant’s Vehicle Style: __________________________________________________________________
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First Color of Vehicle: ______________________________________________________________________
Second Color of Vehicle: ___________________________________________________________________
Miscellaneous
Information
(vehicle):
________________________________________________________________________________________
________________________________________________________________________________________
Defendant’s Place of Employment:____________________________________________________________
Employer’s Address: _______________________________________________________________________
City / State / Zip Code
Employer’s Telephone Number:________________________ Shift worked____________________________
Does Defendant have access to any weapons? Yes / No
Is this an eviction? Yes / No
Hearing Date: _________________________
Plaintiff Information:
________________________________________________________________________________________
First
Middle
Sex: Male / Female
Last
Suffix (Jr, Sr, etc.)
Race: Caucasian / African American / Hispanic / Latino /
Asian American / Pacific Islander / Other _________________________
Date of Birth: _____/_____/_______
Plaintiff Telephone Number:_________________________________________________________________
____ Address is confidential
Address is: _________________________________________________________________________________
City /State /Zip Code
Attorney Name: ______________________________________ Phone No.: ____________________________
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Other Protected Person(s):
1. _____________________________________________________________________________________
First
Sex: Male / Female
Middle
Last
Suffix (Jr, Sr, etc.)
Race: Caucasian / African American / Hispanic / Latino /
Asian American / Pacific Islander / Other _________________________
Date of Birth: _____/______/________
Telephone Number:________________________________________________________________________
_________Same Address of Person Above
Address: ________________________________________________________________________________
City / State / Zip Code
2. ______________________________________________________________________________________
First
Sex: Male / Female
Middle
Last
Suffix (Jr, Sr, etc.)
Race: Caucasian / African American / Hispanic / Latino /
Asian American / Pacific Islander / Other ___________________________
Date of Birth: _____/______/_________
Telephone Number:________________________________________________________________________
____Address is same as the Person above.
Address: ________________________________________________________________________________
City /
State
/ Zip Code
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