LEAVE THIS SPACE BLANK| |SEX +--------------+ | |__________ |FBI No. | | |RACE +--------------+ |LAST NAME FIRST NAME MIDDLE NAME| -----------------------------|----------------------------------+---------- SIGNATURE OF PERSON |CONTRIBUTOR |ALIASES |HT. |WT. FINGERPRINTED |AND ADDRESS | |(IN.)| | | |_____|____ | | |DATE OF -----------------------------| | |BIRTH RESIDENCE OF PERSON | | |__________ FINGERPRINTED | | |HAIR |EYES | | | | -----------------------------|--------------------------------------------- OCCUPATION |ARREST NUMBER|LEAVE THIS SPACE BLANK | | -----------------------------|-------------| SCARS AND MARKS |PLACE OF | |BIRTH | 9 R |-------------|CLASS__________________________ -----------------------------|CITIZENSHIP | 2 R SIGNATURE OF OFFICIAL |DATE | _ | TAKING FINGERPRINTS | ||_|CHECK IF | | | NO CRIMINAL|REF.___________________________ | | RECORD IS | | | DESIRED | --------------------------------------------------------------------------- 1. RIGHT THUMB|2. RIGHT INDEX|3. RIGHT |4. RIGHT RING |5. RIGHT LITTLE | | MIDDLE | | | | | | [Illustration]|[Illustration]|[Illustration]|[Illustration]|[Illustration] | | | | --------------------------------------------------------------------------- \ | R | \ | W | \ --------------------------------------------------------------------------- 1. LEFT THUMB |2. LEFT INDEX |3. LEFT M|4. LEFT RING |5. LEFT LITTLE 18| 10| MIDDLE I| I| 13 | | | | [Illustration]|[Illustration]|[Illustration]|[Illustration]|[Illustration] | | | | --------------------------------------------------------------------------- / | R | / | W | / ---------------------------------------------------------------------------