Fill and Sign the Wa Criminal 497430311 Form

WASHINGTON STATE PATROL Identification and Criminal History Section PO Box 42633 Olympia WA 98504-2633 (360) 705-5100 https://watch.wsp.wa.gov REQUEST FOR CONVICTION CRIMINAL HISTORY RECORD (RCW 10.97) INSTRUCTIONS: PLEASE COMPLETE THIS FORM WHEN REQUESTING CONVICTION CRIMINAL HISTORY RECORD INFORMATION FROM THE IDENTIFICATION AND CRIMINAL HISTORY SECTION. MAIL REQUEST TO ADDRESS NOTED ABOVE WITH $35 . 00 CHECK OR MONEY ORDER OR COME TO OUR OFFICE AT 3000 PACIFIC AVENUE, OLYMPIA, WA. NOTE: IT MAY TAKE 7 TO 14 BUSINESS DAYS FOR RESPONSE WHEN MAILED . FOR AN IMMEDIATE RESPONSE, ACCESS OUR WEB SITE LISTED ABOVE TO CONDUCT YOUR CRIMINAL HISTORY REQUEST FOR $10.00 USING A CREDIT CARD. NOTARIZED LETTERS ARE AN ADDITIONAL $5.00 PER NOTARY SEAL Notarized Letter(s) WSP USE ONLYNOTE: The requested record information is furnished solely on the basis of name and/or description similarity with the subject of your inquiry. Positive identification or non-identification can only be effected upon receipt of fingerprints. Applicant may be advised of inquiry. SUBJECT INFORMATION: (Please type or print clearly ) Applicant's Name: Last First Middle Alias/Maiden Name: Date of Birth: Sex: Race: Month/Day/Year Social Security Number: Drivers Lic. Number/State /A REQUESTER INFORMATION: (Please type or print clearly) DATE: / / Mo. Day Yr. (print) Name/Title of Requester PHONE No. ( ) Requester's Signature REQUESTER'S ADDRESS: (type or clearly stamp address) Requesting Agency Name Address City State ZIP Code 3000-240-569 (R 3/07) B Right Thumb Print (Optional)(optional)