New York State Intelligence Center Latham, New York 12110 Main: FAX: Pe Toll-free: REQUEST FOR INFORMATION FORM RICS Control #: Rank: Received/Entered By: Last Name: Date: Time: Tax / SS#: REQUESTOR’S INFORMATION jmnry Name and NY03030C9 Command/Unit: — Child Exploit T/F ae Exnlonction Workplace (Full Address): 26 Federal Plaza, New York, NY 10278 Last Name | First Name: |] Rank/Title: Detective Tax # NYPD Only: Mss: Date of Appointment: 08/30/1993 Office #: FY Fax #: FY Pager/Cell#: PF Pin: TZS/Pct. Of Oce.: Compl#: Case#: 2017-212 Conferred w/ Requestor Date: Time: Supervisor's Rank/Full Name: iii Phone Number: = Cts Last Name: Maxwell First Name: Ghislaine Middle: N Aliases: DOB: Moke 7 Sex: F Race: W POB: Gang Name: Bldg# Street: Apt: City: State: ZIP Code: Tel# SSN# Driver License#: Ee State/Country: = FL Arrest: FBI#: NYSID#: Other State SID#: Business Bldg: Street: City State: Zip Code Tel#t: Last Name: First Name: (Circle One) Owner/Mgr/Employee Tax ID#: Financial Institution: Account Type: Plate #: State/Country: Year: Make: Model: No. Doors/Body Style: Color: Gray VINA: REMARKS What have you (Requestor) done? | What needs to be done by NYSIC personnel? I am requesting a CIAS search of the above named female for the past one year. OR to verify that your FAX was received!) EMAIL Request to NYSIC: (You MUST call FAX Request to NYSIC: EFTA00038389