Get State Of Iowa Criminal History Record Check Request Form

STATE OF IOWA Criminal History Record Check Request Form DCI Account Number 9861-F if applicable To Iowa Division of Criminal Investigation Support Operations Bureau 1st Floor 215 E. 7th Street From City Clerk s Office City of Cedar Rapids 101 First Street SE Cedar Rapids IA 52401 Des Moines Iowa 50319 515 725-6066 515 725-6080 Fax Phone 319-286-5060 Fax I am requesting an Iowa Criminal History Record Check on Last Name mandatory First Name mandatory Middle Name mandatory Date of Birth mandatory Gender mandatory Social Security Number mandatory Male Female Waiver Information Without a signed waiver from the subject of the request a complete criminal history record may not be releasable per Code of Iowa Chapter 692. 2. For complete criminal history record information as allowed by law always obtain a waiver signature from the subject of the request. Waiver Release I hereby give permission for the above requesting official to conduct an Iowa criminal history record check with the Division of Criminal Investigation DCI. Any criminal history data concerning me that is maintained by the DCI may be released as allowed by law. Waiver Signature Date Iowa Criminal History Record Check Results As of a search of the provided name and date of birth revealed DCI initials DCI-77 08/25/10 DCI use only. 2. For complete criminal history record information as allowed by law always obtain a waiver signature from the subject of the request. Waiver Release I hereby give permission for the above requesting official to conduct an Iowa criminal history record check with the Division of Criminal Investigation DCI. Waiver Release I hereby give permission for the above requesting official to conduct an Iowa criminal history record check with the Division of Criminal Investigation DCI. Any criminal history data concerning me that is maintained by the DCI may be released as allowed by law. Any criminal history data concerning me that is maintained by the DCI may be released as allowed by law. Waiver Signature Date Iowa Criminal History Record Check Results As of a search of the provided name and date of birth revealed DCI initials DCI-77 08/25/10 DCI use only. 2. For complete criminal history record information as allowed by law always obtain a waiver signature from the subject of the request. Waiver Release I hereby give permission for the above requesting official to conduct an Iowa criminal history record check with the Division of Criminal Investigation DCI. Any criminal history data concerning me that is maintained by the DCI may be released as allowed by law. Waiver Release I hereby give permission for the above requesting official to conduct an Iowa criminal history record check with the Division of Criminal Investigation DCI. Any criminal history data concerning me that is maintained by the DCI may be released as allowed by law. Waiver Signature Date Iowa Criminal History Record Check Results As of a search of the provided name and date of birth revealed DCI initials DCI-77 08/25/10 DCI use only.