Criminal_History_Request_Form.pdf

Date of Record Search: ______________ Record Searched By:_______________ Release Authorization: ________________

Date of Request: (Numbers Only) Metropolitan Police Department Washington, D.C

Criminal History Request

Social Security Number: (Numbers Only)

Request Record of: (Last, First, Middle Name)

Address:

Sex: Race: Birthdate: (Numbers Only) Place of Birth:

Requesting Agency:

District of Columbia Courts Call-Back Number:

(202) 879-0496

IDENTIFICATION AND RECORDS DIVISION USE ONLY - (Check if applicable)

Request Received By: Date and Time Received: Date and Time Returned:

Purpose of Request:

Signature of Agent: Badge No.: Method of Request:

D.C. Code § 6-2276 IS QUOTED HERE FOR YOUR INFORMATION

It shall be an unlawful practice, punishable by a fine of not more than three-hundred dollars ($300), or imprisonment for not more than ten (10) days, or both, for any person to require the production of and arrest record or any copy, extract, or statement thereof, at the monetary expense of any individual to whom such record may relate. Such "arrest records" shall contain only listings of convictions and forfeitures of collateral that have occurred within ten (10) years of the time at which such record is requested. (Dec. 13, 1977, D.C. Law 2-38, Title II, § 266, 24 DCR 6038).

*I hereby authorize the release of my adult arrest record revealing convictions and forfeitures within the past ten (10) years.

Signature Date

RESULTS OF CRIMINAL HISTORY FILE SEARCH

TO: Criminal History Users This request concerns information whose collection, dissemination, and use are conditioned and restricted by applicable federal and District of Columbia statutes, and policy of the Metropolitan Police Department. Continued assistance from this department is conditioned upon your strict adherence to these regulations.

WARNING TO APPLYING AGENCIES: The Metropolitan Police Department does not guarantee either the accuracy of the record or that the individual whose record is furnished is actually the same individual whose record was requested. To obtain accuracy, the record of the Court involved should be examined. Positive identification can only be determined by comparable fingerprints. Records of arrests obtained from the Metropolitan Police Department as detailed on this form are for convictions and forfeitures for the past 10 years prior to the date of request of this record, exclusive of periods of imprisonment, if any. This record does not reflect any cases which may be currently pending before the Courts or cases where convictions have been set aside pending appeals.

CHIEF OF POLICE

Date of Arrest DispositionCharge(s)

Documents Released:

Criminal History Record

Prosecution Report

Photograph

Fingerprints Other:

Other:

Mail

In Person

NLET

Telephone

Law Enforcement (non-employment)

Visas*

Employment/ Licensing*

Challenge*

SUBJECT UNDER ARREST CORRECT COLOR CODE

Name Search Fingerprint Search

PowerPoint Presentation Meghan Aberle D:20060213145527- 05'00' D:20060213145600- 05'00' Date of Record Search: ______________ Record Searched By:_______________ Release Authorization: ________________ Date of Request: (Numbers Only) Metropolitan Police Department Washington, D.C Criminal History Request Social Security Number: (Numbers Only) Request Record of: (Last, First, Middle Name) Address:

Sex:

Race:

Birthdate: (Numbers Only) Place of Birth:

Requesting Agency:

District of Columbia Courts Call-Back Number:

(202) 879-0496

IDENTIFICATION AND RECORDS DIVISION USE ONLY -

(Check if applicable) Request Received By:

Date and Time Received:

Date and Time Returned:

Purpose of Request:

Signature of Agent:

Badge No.:

Method of Request:

D.C. Code § 6-2276 IS QUOTED HERE FOR YOUR INFORMATION It shall be an unlawful practice, punishable by a fine of not more than three-hundred dollars ($300), or imprisonment for not more than ten (10) days, or both, for any person to require the production of and arrest record or any copy, extract, or statement thereof, at the monetary expense of any individual to whom such record may relate. Such "arrest records" shall contain only listings of convictions and forfeitures of collateral that have occurred within ten (10) years of the time at which such record is requested. (Dec. 13, 1977, D.C. Law 2-38, Title II, § 266, 24 DCR 6038).

*I hereby authorize the release of my adult arrest record revealing convictions and forfeitures within the past ten (10) years.

____________________________________________________ ________________ Signature Date

RESULTS OF CRIMINAL HISTORY FILE SEARCH

TO: Criminal History Users This request concerns information whose collection, dissemination, and use are conditioned and restricted by applicable federal and District of Columbia statutes, and policy of the Metropolitan Police Department. Continued assistance from this department is conditioned upon your strict adherence to these regulations.

WARNING TO APPLYING AGENCIES: The Metropolitan Police Department does not guarantee either the accuracy of the record or that the individual whose record is furnished is actually the same individual whose record was requested. To obtain accuracy, the record of the Court involved should be examined. Positive identification can only be determined by comparable fingerprints. Records of arrests obtained from the Metropolitan Police Department as detailed on this form are for convictions and forfeitures for the past 10 years prior to the date of request of this record, exclusive of periods of imprisonment, if any. This record does not reflect any cases which may be currently pending before the Courts or cases where convictions have been set aside pending appeals.

CHIEF OF POLICE

Date of Arrest Disposition Charge(s) Documents Released: