Free LIVESCAN Fingerprint Request - Michigan


File Size: 21.9 kB
Pages: 1
File Format: PDF
State: Michigan
Category: Secretary of State
Author: Michigan Department of State
Word Count: 103 Words, 940 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.michigan.gov/documents/sos/LIVESCAN_FINGERPRINT_REQUEST_174423_7.pdf

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LIVESCAN FINGERPRINT REQUEST
Date fingerprinted: __________ Type of picture ID presented: ___________

APPLICANT INFORMATION
Must provide a picture ID to be printed

Applicant Name _______________________________________________
Last, first, middle

Date of Birth ____________

Race ______

Sex ______

Applicant address ______________________________________________ ___________________________________Zip ________ Applicant phone number _________________________________________

REQUESTING AGENCY INFORMATION
Agency ID: 1340A
(RQID)

Agency Name: Bureau of Regulatory Services

Reason fingerprinted:
AR­Department of State, Bureau of Regulatory Services

**Disclaimer: Any and all fingerprints processed with incorrect fingerprint codes/reasons, etc are the responsibility of the REQUESTING AGENCY. MSP will charge for second requests due to incorrect fingerprint reason.
L-1 Identity Solutions 1-800-377-2080 www.L1id.com