Request Form For Morphotrust Usa Cardscan Fingerprinting Services - Nys Division Of Criminal Justice Services (Dcjs) Record Review Program Page 3
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Fingerprint Certification Form
*Applicant Name: ____________________________________________________________________________
To be filled in by Fingerprinting Officer:
*Name/Title: _______________________________________________________________________________________
*Agency: __________________________________________________________________________________________
*Address: _________________________________________________________________________________________
*Signature: _________________________________________________ *Fingerprinting Date: _____________________
*Please check the two forms of identification provided by applicant including one with a photograph.
Column A (must have photograph):
Column B:
Unexpired U.S. Passport
U.S. Military Service Record (Form DD-214);
Permanent Resident Card or Alien Registration
Military Dependent’s Identification Card
Receipt Card (Form I-551)
Native American tribal document
Unexpired foreign passport
U.S. Tribal or Bureau of Indian Affairs
Unexpired Employment Authorization Document
Identification Card
that contains a photograph (Form I-766);
U.S. Social Security card
Unexpired driver’s license issued by a state or
Original or certified copy of a birth certificate
Territory of the U.S. provided it contains a
issued by a state, county, municipal authority or
photograph and information including the name,
Territory of the United States, bearing an official
date of birth, gender, height, eye color and
seal
address
Certification of Birth Abroad issued by the U.S.
Unexpired ID card issued by a federal, state, or
Department of State
local government agency or a government
Student Visa (F1/M1) issued by the U.S. Bureau
agency of a Territory of the U.S., provided it
of Consular Affairs
contains a photograph and information such as
International Driving Permit
name, date of birth, gender, height, eye color
Unexpired Foreign Driver’s License
and address
Unexpired U.S. Visa issued by the U.S.
Uniformed Services Identification Card (Form
Department of Consular Affairs for travel to or
DD-1172-2)
within, or residence within, the United States
U.S. Military Identification Card
(Examples: Temporary Worker Visa
U.S Coast Guard Merchant Mariner Card
(B1/B2/H1B/H2B/L1/TN1), Permanent
Unexpired Canadian Driver’s License
Employment Visa (EB 1-5), Visitor Visa (B2),
Federal Government Personal Identity Card
Cultural Exchange Visa (J1), or Temporary Non-
(PIV)
Immigrant Religious Worker Visa (R1)
Department of Defense Common Access Card
U.S. Citizen ID Card (Form I-197)
School Student ID card with a photograph (when
Certificate of Citizenship (N-560)
accompanied by an original or certified copy of a
Replacement of Certificate of Citizenship (N-
birth certificate issued by a state, county,
561)
municipal authority or a Territory of the United
Certificate of Naturalization (N-550)
States, bearing an official seal, a U.S. Social
Replacement Certificate of Naturalization (N-
Security Card, or a Student Visa (F1/M1) issued
570)
by the U.S. Department of Consular Affairs)
*For persons under age of 18 with no photo identification, you must provide one form of identification from
Column B AND one of the following:
A certified school record or report card; OR
Clinic, doctor or hospital record.
Forward all forms and documentation to:
New York State Division of Criminal Justice Services
th
Record Review Unit- 5
Floor
80 South Swan Street
Albany, New York 12210
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