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FBI 1164 Identity History Summary Request 110120

FBI fingerprinting form - blank copy

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NIkada
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260 views1 page

FBI 1164 Identity History Summary Request 110120

FBI fingerprinting form - blank copy

Uploaded by

NIkada
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PERSONAL

IDENTITY IDENTIFICATION
HISTORY
IDENTITY SUMMARY LAST NAME
TYPE OR PRINT ALL INFORMATION IN BLACK
NAM FIRST NAME MIDDLE NAME
FBI LEAVE BLANK

REQUEST
SEE REVERSE SIDE FOR FURTHER INSTRUCTIONS
FD-1164 (Rev. 11-1-20)
FD-353 (Rev. 5-15-17) 1110-0046
_________________________________________________________
FD-XXX (Rev.X-XX-20
______________________________________________________________________________________
SIGNATURE OF REQUESTOR
SIGNATURE PERSON FINGERPRINTED FINGERPRINTS SUBMITTED BY

DC000000Z
RESIDENCE DATE OF BIRTH DOB YYYY/MM/DD
ADDRESS OF PERSON FINGERPRINTED
Month Day Year

DATE FINGERPRINTED SEX RACE HGT. WGT. EYES HAIR PLACE OF BIRTH POB
PERSON TO BE NOTIFIED IN CASE OF EMERGENCY

NAME SOCIAL SECURITY NO.


LEAVE BLANK

ADDRESS
CLASS
MISCELLANEOUS NO.

FINGERPRINTED BY
REF.
SCARS AND MARKS

1. R. THUMB 2. R. INDEX 3. R. MIDDLE 4. R. RING 5. R. LITTLE

6.L. THUMB 7. L. INDEX 8. L. MIDDLE 9. L. RING 10. L. LITTLE

LEFT FOUR FINGERSTAKEN SIMULTANEOUSLY L. THUMB R. THUMB RIGHT FOUR FINGERS TAKEN SIMULTANEOUSLY

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