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Get Scan Service Form 2016-2024

D prior to having your fingerprints taken. The following information must be printed or typed on the form. All other spaces on the form should remain blank. Name of Applicant: Enter your full name. Alias: Enter any other names you have used. Date of Birth: You must provide your date of birth in order for the Secretary of State’s Office to process your background check. Sex: Gender (male or female) Height Weight Eye Color Hair Color Place of Birth SOC: Social Security Number. Driver’s License.

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