Request For Nevada Criminal History General Services (Page 3 of 3) in pdf

Request For Nevada Criminal History General Services Page 3

Department of Public Safety

General Services Division

Attn: Fingerprint Support Unit

333 West Nye Lane, Suite 100

Carson City, Nevada 89706

IDENTIFICATION FILE REQUEST FOR

STATE OF NEVADA RECORDS OF CRIMINAL HISTORY FORM

I hereby authorize the State of Nevada Criminal History Repository to disclose

criminal history record information, if any, within my identification file to me or the

person or entity indicated below:

Today’s Date: ____________________________

Please indicate the full name, address and contact information of the individual to

be searched below (to be completed by the subject of the record).

First Name: __________________________________________

Middle Name: ________________________________________

Last Name: __________________________________________

Mailing Address: ______________________________________

Street Address

______________________________________

City, State and Zip Code

Contact Phone: __________________ Contact Email: ____________________

(If available)

________________________________________

____________________

Signature of Subject of Record Search

Date of Birth

Please indicate the complete response mailing information below:

Respond To: _________________________________________

Mailing Address: ______________________________________

Street Address

_________________________________________________________

City, State and Zip Code

Please indicate reason for request: ________________________

(Optional)

The use of this form is intended to safeguard the rights of the signatory and ensure the confidentiality of the requested

information against non-authorized disclosure. The fingerprint card accompanying this request will be used to verify

identity. A $23.50 certified check or money order made payable to the Department of Public Safety must accompany

each request.

Page 3 of 3

DPS-006 Form

Revised 4.15.2014

Request For Nevada Criminal History General Services Page 3