Request To Change Criminal History Form

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Kansas Bureau of Investigation
Criminal History Records Central Repository
Phone (785) 296-2454
Fax (785) 368-7162
REQUEST TO CHANGE CRIMINAL HISTORY
Directions: Complete this form to update an arrest or summons that was reported to Criminal History on a 10-print fingerprint card. The agency that
submitted the arrest or summons is the only agency that can submit a change request.
Part I - Fill out all the fields to identify the proper criminal history record.
Part II - Only fill out the fields you wish to update.
Part III - Complete all spaces to authorize changes.
Deletions: This form cannot be used to delete an arrest from a criminal history record. If you need an arrest deleted you must write a letter on your agency
letterhead explaining the deletion request in full detail.
Unarrest: There is no option to "unarrest" a subject. If the subject was arrested, released, and no charges will be filed then please fill out this form
requesting the record to be updated to show "Released with no further action" in the Additional Information section.
Part I. Identifiers currently shown in the central repository record:
Last Name
First Name
Middle Name
Date of Birth
SSN
Sex
Race
SID Number
PCN
Transaction Number
Date of Arrest
Part II. Data identified in the record above should be changed as follows:
Last Name
First Name
Middle Name
Date of Birth
SSN
Sex
Race
Height
Weight
Eyes
Hair
Place of Birth
Address
City
State
Zip
ORI Update
Scars, Marks, Tattoos
Statute
Literal
Additional Information
Part III. Agency Verification:
Contributor of Change
ORI
Signature of Official Authorizing Change
Phone Number
Date
Revised 06/02/2015

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