15F06719R0000004_0007,_Atch_17_FBI_LAR_Guide_&_SF_85.pdf

FBI Limited Escorted Access Request (LAR) Completion Guide

Please read and follow these instructions when completing the Standard Form 85 (SF 85).

Only provide the information requested in this checklist.

QUESTION NUMBER INSTRUCTIONS

1. Full Name Last, First Middle

• Provide full middle name

• If no middle name, put “NMN” or “NONE”

2. Date of Birth MM/DD/YYYY format

3. Place of Birth

• If born in the U.S. list City and State

• If born outside the U.S. list City and Country

4. Social Security Number ###-##-#### format

5. Other Names Used Alias’s , AKA’s, Maiden Names, nicknames

• Full Name

• Dates used MM/YY to MM/YY format

6. Sex Male or Female

7. Citizenship Answer the question according to the form as applicable to you.

8. Where You Have Lived (Residence)

Provide complete address information for your current residence only.

10. Your Employment Activities

Provide complete information for your current employer only.

14. Illegal Drugs Respond to this question accurately use MM/YY format for dates.

Continuation Space

List any current or recent criminal charges within the previous one year from the date you sign this form.

Name of Charge:

Date of Charge:

Law Enforcement Agency or Department involved:

Court Involved:

Disposition and Date:

Additional Details:

Authorization for Release of Information

Complete all fields.

• The release MUST be signed.

• Use N/A if no other names are used.

• Make sure you provide the date signed and not your date of birth.

EANDRADE

Text Box List any current or recent criminal charges within the previous one year from the date you sign this form.

Name of Charge:

Date of Charge:

Law Enforcement Agency or Department involved:

Court Involved:

Disposition and Date:

Additional Details: