Call 954-404-9789. Fax 954-391-9859.
Type or Print all information in Black Ink. DO NOT SIGN the fingerprint card until your signature can be witnessed by the official taking your fingerprints.
LAST NAME, FIRST NAME, MIDDLE NAME: In the order listed on the card, print your complete name. Do not modify any portion of your name to fit the card. For example, if your identification shows the suffix II, do not change it to Jr. on the card. If your last name is hyphenated, do not drop either name.
SIGNATURE OF PERSON FINGERPRINTED: You must show proof of your identity to the person taking your fingerprints. After examining your proof of identity, you should sign your full name being sure your signature is witnessed by the person taking your fingerprints.
ALIASES AKA: List all other names you have used including maiden name(s).
DATE OF BIRTH DOB: Enter your date of birth as MMDDYY. Example: Enter April 21, 1955 as 04/21/55
RESIDENCE OF PERSON FINGERPRINTED: List the current full mailing address.
DATE: Enter the date your fingerprint card is completed. This date cannot be more than 1 year from date of submission to authorities.
SIGNATURE OF OFFICIAL TAKING FINGERPRINTS: This line must be completed with the signature of the person taking your fingerprints. They should print their name underneath their signature.
CITIZENSHIP CTZ: Enter the name of the country where you are a citizen. Enter US for United States citizens. For foreign citizens, Use the two-character foreign country codes used by criminal justice agencies for federal reporting. All law enforcement agencies have a set of codes.
SEX: Enter either M (male) or F (female).
RACE: Use one of the following codes: A – Asian N – Native Hawaiian/Pacific Islander
W – White I – American Indian/Alaskan Native HEIGHT HGT: Enter your height in feet and inches. Do not use fractions of an inch.
WEIGHT WGT: Enter weight in pounds and round to the nearest pound. Do not use fractions of pounds. EYES: Use one of the following three-character codes:
B – Black
U – Unknown
GRY – Gray XXX – Unknown
BRO – Brown PLE – Purple WHI – White
BLK – Black BLU – Blue HAZ – Hazel MAR – Maroon
HAIR: Use one of the following three-character codes:
BRO – Brown GRN – Green MUL – Multi-colored PNK – Pink
BAL – Bald GRN – Green PNK – Pink
BLK – Black
GRY – Gray
RED – Red or Auburn
BLN – Blond or Strawberry ONG – Orange
SDY – Sandy
PLACE OF BIRTH POB: Enter the two-character code for the state you were born in. If you were not born in the United States, enter the foreign country codes used by criminal justice agencies for federal reporting.
EMPLOYER AND ADDRESS: Enter name and address of your current employer.
REASON FINGERPRINTED: This entry will be completed by the Office of the State Bank Commissioner. SOCIAL SECURITY NO. SOC: Enter your Social Security number or work visa number.
The following headings should be left blank: OCA, FBI, MNU, and MISCELLANEOUS NO. MNU