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Applicant And Personal Identification Card RI8 - Michigan
| Applicant And Personal Identification Card Form. This is a Michigan form and can be used in General Securities Blue Sky Secretary Of State . |
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1. NAME (LAST, FIRST, MIDDLE) MSP USE ONLY A 2. DATE OF BIRTH 3. RACE 4. SEX Scanned Sorted 5. IMPRESSIONS TAKEN BY 6. BADGE NO.7. DATE PRINTED 10. SIGNATURE OF PERSON PRINTED (IN OWN WRITING) 8. REVIEWED BY 9. AGENCY 11. ADDRESSB 12. CITY 13. STATE 14. ZIP CODE 12a. COUNTY C 1. R. THUMB 2. R. INDEX 3. R. MIDDLE 4. R. RING 5. R. LITTLE6. 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 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 COMPLETE SECTIONS D THRU F WITH TYPEWRITER ONLY DO NOT FOLD FINGERPRINT CARD 15. NAME OF APPLICANT (LAST, FIRST, MIDDLE) 16. DATE OF BIRTH 50. SID NO. 17. RACE 18. SEX 19. HT. 20. WT. 21. HAIR 22. EYES 23. DRIVER LIC. NO. (STATE) 24. SOCIAL SECURITY NUMBER*D 25. STATE OR COUNTY 26. MARKS, SCARS, AMPS, TATTOOS, ETC.27. ADDITIONAL NAMES (LAST, FIRST, MIDDLE) OF BIRTH 28. APPLICANT FOR: LIQUOR LICENSE (R 436.1113 & 436.1115) NAME CHANGE (MCL 711.1) PERSONAL USE (MCL 28.271) ADOPTION (MCL 28.271) CHILD PROTECTION (PL104-120) 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) FAMILY INDEPENDENCE AGENCY EMPLOYMENT, DEPT. OF (DSS POLICY) SET-A-SIDE CONVICTION (MCL 780.621) SECURITIES (MCL 451.602) E OTHER (1935 PA 59) (specify) SEARCH REQUIREMENT Check the criminal File(s) that must be searched for the applicant rea son selected. Fees will be charged according to this selection. If there is no selection, only the state file will be se arched. State Only FBI & State 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 Date COMPLETE THIS BOX TO ENSURE CORRECT MAILING OF RESPONSE 29. SEND RESPONSE TO: Requestor ID #: NAME/AGENCY F ADDRESS CITY STATE ZIP CODE APPLICANT AND PERSONAL IDENTIFICATION CARD RI-008 (5-2003) G MICHIGAN STATE POLICE Criminal Justice Information Center General Office Building, 7150 Harris Drive, Lansing, MI 48913 * Social Security Number is confidential. Disclosure of confidential inf ormation is protected by the Federal Privacy Act. AUTHORITY: 1935 PA 59 / COMPLIANCE: Voluntary. IMPORTANT: INFORMATION PROVIDED ON THIS FORM MAY BE COMPUTERIZED IN STAT E FILES. American LegalNet, Inc. www.USCourtForms.com
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