Alarm Agent Registration with Firearm Request for Live Scan ...
Alarm Agent Registration with Firearm Request for Live Scan ...
Alarm Agent Registration with Firearm Request for Live Scan ...
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REQUEST FOR LIVE SCAN SERVICEApplicant SubmissionORI: A0522 Type of Application: <strong>Alarm</strong> <strong>Agent</strong> w/<strong>Firearm</strong>sCode assigned by DOJJob Title or Type of License, Certification or Permit:ACE/FQ <strong>Alarm</strong> <strong>Agent</strong> w/<strong>Firearm</strong>sAgency Address Set Contributing Agency:Bureau of Security & Investigative Services 06078Agency authorized to receive criminal history in<strong>for</strong>mationMail Code (five digit code assigned by DOJ)P.O. BOX 989002LicensingStreet No. Street or P.O. Box Contact Name (Mandatory <strong>for</strong> all school submissions)West Sacramento CA 95798-9002 (916) 322-4000City State Zip Code Contact Telephone No.Name of Applicant:(please print) Last First MIAlias:LastFirstDriver’s License No.Date of Birth: Sex: Male Female Misc. No. BIL- N/AAgency Billing Number (if applicable)Height: Weight: Misc. No:Eye Color: Hair Color: Home Address:Place of Birth:SOC:Street or P.O. BoxCity, State and Zip CodeYour Number: Level of Service X DOJ X FBIOCA No. (Agency Identifying No.)If resubmission, list Original ATI No.Employer: (Additional response <strong>for</strong> agencies specified by statute)Employer NameStreet No. Street or P.O. Box Mail Code (five digit code assigned by DOJ)( )City State Zip Code Agency Telephone No. (optional)<strong>Live</strong> <strong>Scan</strong> Transaction Completed By:Name of OperatorDate:Transmitting Agency ATI No. Amount Collected/BilledBCII 8016 (Rev 04/01) ORIGINAL – <strong>Live</strong> <strong>Scan</strong> Operator, SECOND COPY – <strong>Request</strong>ing Agency, THIRD COPY - Applicant