EFTA00038391

New York State Intelligence Center Latham, New York 12110 REQUEST FOR INFORMATION FORM Main: FAX: Toll-free: DATE & TIME OF REQUEST MEMBER/ANALYST ASSIGNED RICS Control #: Rank: Received/Entered By: Last Name: Date: Time: Tax / SS#: REQUESTOR'S INFORMATION Agency Name and NY03030C9 Command/Unit: Child Exploit T/F Investigation Sex Trafficking ORI: Type: Workplace (Full Address): 26 Federal Plaza, New York, NY 10278 Last Name First Name: Rank/Title: Detective Tax # NYPD Only: SSN: Date of Appointment: 08/30/1993 Office #: Fax #: Pager/Cell#: Pin: TZS/Pct. Of Occ.: Compl#: Case#: 31E-NY- Conferred w/ Requestor Date: Time: 302870 - Phone Number: Supervisor's Rank/Full Name: LT SUBJECT INFORM TION Last Name: First Name: Middle: Aliases: DOB: Age: Sex Race: POB: Gang Name: Bldg# Street: Apt: City: State: Tel# SSN# Code: Driver License#: State/Country: Arrest: FBI#: NYSID/4: Other State SID#: BUSINESS LOCATION & FINANCIAL INFORMATION Business Bldg: Street: Name: City State: Zip Code Tel#: Last Name: First Name: (Circle One) Owner/Mgr/Employee Tax ID/4: Financial Institution: Account Type: VEHICLE INFORMATION Plate #: State/Country: MA Year: 19 Make: CHEV Model: Gray VIN#: No. Doors/Body Style: Color: 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: ciu6i)nvsic.nv.eov OR EFTA00038391 to verify that your FAX was received!) EFTA00038392