New York State Intelligence Center Latham, New York 12110 Main: FAX: Fe Toll-free: REQUEST FOR INFORMATION FORM RICS Control #: Rank: Received/Entered By: Last Name: Date: Time: Tax / SS#: REQUESTOR’S INFORMATION paral Name and NY03030C9 Command/Unit: Child Exploit T/F all Ex oe on 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#: fF Pin: TZS/Pct. Of Oce.: Compl#: Case#: 2017-212 Conferred w/ Requestor Date: Time: Supervisor's Rank/Full Name: UT iii Phone Number: == Cte Last Name: Borgerson First Name: Scott Middle: G Aliases: pos: Bi Age: 44 Sex: M_~ Race: W_ POB: Gang Name: Bldg# Street: Apt: City: State: ZIP Code: Tel# SSN# Driver License#: | sO State/Country: MA Arrest: FBI#: NYSID#: Other State SID#: Business Bldg: Street: City State: Zip Code Tel#: 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 male for the past one year. EMAIL Request to NYSIC: ciu@nysic.ny.gov OR (You MUST call to verify that your FAX was received!) FAX Request to NYSIC: EFTA00038390