Main: FAX: Toll-free: New York State Intelligence Center Latham, New York 12110 REQUEST FOR INFORMATION FORM RICS Control #: Rank: Received/Entered By: Last Name: Date: Time: Tax / SS#: REQUESTOR’S INFORMATION fenrd Name and NY03030C9 Command/Unit: Child Exploit T/F anal Sex Trafficking Workplace (Full Address): 26 Federal Plaza, New York, NY 10278 Last Name | | First Name: | | Rank/Title: Detective Tax # NYPD Only: ss: Date of Appointment: 08/30/1993 Office #: FT Fax #: Pager /Cell#: fT Pin: TZS/Pet. Of Oce.: Compl#: Case#: eee Conferred w/ Requestor Date: Time: Supervisor's Rank/Full Name: yy LULULLL—S—szY Phone Number: ZZ Last Name: First Name: Middle: Aliases: DOB: Age: Sex Race: POB: Gang Name: Bldg# Street: Apt: City: State: ie: Tel# SSN# Driver License#: State/Country: 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: MA Year: 19 Make: CHEV ~~ Model: No. Doors/Body Style: Color; = —OTY. VINE: 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 EFTA00038391

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FAX Request to NYSIC: (You MUST call to verify that your FAX was received!) EFTA00038392