Fillable Livescan Fingerprint Request Form printable pdf download

Livescan Fingerprint Request Form

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LIVESCAN FINGERPRINT REQUEST

Instructions for Applicant:

1. Complete APPLICANT INFORMATION below.

2. Schedule an appointment to be fingerprinted:

a. Visit

b. In the Search box, type “Private Livescan Vendors,” and click on Go.

c. Select the

MSP – Private Live Scan Vendors

link for list of vendors.

3. Attend appointment, pay fee, and keep the receipt.

4. Bring picture ID and this completed form to the appointment.

Criminal history report will be forwarded to the Department of State by the Michigan State Police.

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

Agency Name: Bureau of Driver and Vehicle Programs

(RQID)

Reason fingerprinted:

AR–Department of State, Bureau of Driver and Vehicle Programs

**Disclaimer: Any and all fingerprints processed with incorrect fingerprint codes/reasons, etc, are the

applicant’s responsibility. Michigan State Police will charge for second requests due to incorrect

fingerprint reason.

Rev. 04/2016

Livescan Fingerprint Request Form

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