"Finger Prints Form"

FEDERAL BUREAU OF INVESTIGATION
UNITED STATES DEPARTMENT OF JUSTICE
WASHINGTON D.C. 20537
PERSONAL IDENTIFICATION

TYPE OR PRINT ALL INFORMATION IN BLACK
LAST NAME       FIRST NAME      MIDDLE NAME

    FBI      LEAVE BLANK

SIGNATURE OF PERSON FINGERPRINTED

FINGERPRINT SUBMITTED BY

DATE OF BIRTH  DOB
          Month           Day          Year

RESIDENCE OF PERSON FINGERPRINTED

DATE FINGERPRINTED

SEX |  RACE |  HGT  | WGT |   EYES

HAIR  |  PLACE OF BIRTH

PERSON TO BE NOTIFIED IN CASE OF EMERGENCY

    NAME________________________________

    ADDRESS_____________________________

_______________________________________
FINGERPRINTED BY

SOCIAL SECURITY NO

LEAVE BLANK

CLASS_________________________

REF___________________________

MISCELLANEOUS NO

SCARS AND MARKS

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