Transcription of REQUEST FOR LIVE SCAN SERVICE - State of California
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REQUEST FOR LIVE SCAN SERVICE - State of California
State OF CALIFORNIADEPARTMENT OF JUSTICEBCIA 8016 visa (orig. 04/2001; rev. 10/2010) REQUEST FOR live scan SERVICE ( visa / immigration ) Applicant SubmissionORI (Code assigned by DOJ)AE709 Authorized Applicant TypeVISA/IMMIGRATIONType of License/Certification/Permit OR Working Title (Maximum 30 characters - if assigned by DOJ, use exact title assigned)Contributing Agency Information:Agency Authorized to Receive Criminal Record InformationDEPARTMENT OF JUSTICES treet Address or Box 903417 CitySACRAMENTOS tateCAZIP Code94203-4170 Mail Code (five-digit code assigned by DOJ)N/AContact Name (mandatory for all school submissions)APPC ontact Telephone Number916-227-6970 Applicant Information:Last NameFirst NameMiddle InitialSuffixOther Name (AKA or Alias)LastFirstSuffixDate of BirthSexMaleFemaleDriver's License NumberHeightWeightEye ColorHair ColorPlace of Birth ( State or Country)Social Security NumberHome AddressStreet Address or BoxCityStateZIP CodeBilling Number(Agency Billing Number)Misc.
STATE OF CALIFORNIA DEPARTMENT OF JUSTICE BCIA 8016VISA (orig. 04/2001; rev. 10/2010) REQUEST FOR LIVE SCAN SERVICE (VISA/Immigration) Applicant Submission
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