New York State Intelligence Center

Latham, New York 12110

New York State

NYSIC

Intelligence Center

Main:
FAX:
Toll-free:

# REQUEST FOR INFORMATION FORM

DATE & TIME OF REQUEST

MEMBER/ANALYST ASSIGNED

RICS Control #:

Rank:

Received/Entered By:

Last Name:

Date:

Time:

Tax / SS#:

## REQUESTOR'S INFORMATION

Agency Name and
ORI:

NY03030C9

Command/Unit: Child Exploit T/F

Investigation
Type:

Sex Trafficking

Workplace (Full Address):

26 Federal Plaza, New York, NY 10278

Last Name

Tax # NYPD Only:

First Name:

Rank/Title:

Detective

Date of Appointment:

SSN:

08/30/1993

Office #:

TZS/Pct. Of Occ.:

Fax #:

Pager/Cell#:

Pin:

Compl#:

Case#:

31E-NY-
302870

Conferred w/Requestor Date:

Time:

Supervisor's Rank/Full Name: LT

Phone Number:

## SUBJECT INFORMATION

Last Name:

First Name:

Middle:

Aliases:

DOB:

Age:

Sex

Race:

POB:

Gang Name:

Bldg#

Street:

Apt:

City:

State:

ZIP

Code:

Tel#

SSN#

Driver License#:

NYSID#:

Arrest:

State/Country:

FBI#:

Other State SID#:

## BUSINESS LOCATION & FINANCIAL INFORMATION

Business

Bldg:

Street:

Name:

City

State:

Last Name:

Zip Code

First Name:

Tel#:

(Circle One)

Owner/Mgr/Employee

Account Type:

Tax ID#: Financial Institution:

# REQUEST FOR INFORMATION FORM (cont.)

## VEHICLE INFORMATION

Plate #:

State/Country:

MA

Year: 19 Make: CHEV Model:

No. Doors/Body Style:

Color:

Gray

VIN#:

REMARKS

What have you (Requestor) done?

What needs to be done by NYSIC personnel?

I am requesting the assistance of the NYSP regarding a CIAS check as well as NYSP, LPR's,.

EMAIL Request to NYSIC: ciu@nysic.ny.gov OR

EFTA00039517

FAX Request to NYSIC:

(You MUST call

to verify that your FAX was received!)

EFTA00039518