Transcription of REQUEST FOR LIVE SCAN SERVICE - State of California
1 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.
2 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. Number(Other Identification Number)Your Number:OCA Number (Agency Identifying Number)Level of SERVICE : DOJ FBIIf re-submission, list original ATI number: (Must provide proof of rejection)Original ATI Number Employer (Additional response for agencies specified by statute):Employer NameStreet Address or BoxCityStateZIP CodeMail Code (five digit code assigned by DOJ)Telephone Number (optional) Live Scan Transaction Completed By:Name of OperatorDateTransmitting AgencyLSIDATI NumberAmount Collected/Billed ORIGINAL - Live Scan Operator SECOND COPY - Applicant
