Date: _____________________________ Phone #:_____________________________

Your Name:_____________________________

Mailing Address :
_____________________________
_____________________________
_____________________________
_____________________________

 

I, ________________________ request a criminal history report on the individual listed below.

You must initial your understanding for each statement below.

_______	The report will take a minimum of 48 hours to be compiled and will be mailed to me.
_______	The report is based on the information I supplied to the Sheriff’s Office. If I provide incorrect information, the Sheriff’s Office is not responsible.
_______	information contained in this report is for Washoe County ONLY.
_______	You must contact other police agencies for conviction information outside Washoe County (i.e. Southern Nevada, California).
_______	The arrest information will contain adult arrest information dating back ten years from the date of this request.
_______	information does not include citation or juvenile information.

 

____________________________________________
Signature

Person of Inquiry:

FULL NAME: ______________________________________________________________
ADDRESS: _______________________________________________________________
DATE OF BIRTH: ____________________ SOCIAL SECURITY: ______________________
RECEIPT # ____________________________________(For use by WCSO employee only)