EFTA00038390.pdf

Type: pdf
Source set: data-set-8
Extracted text

New York State Intelligence Center
Latham, New York 12110 
REQUEST FOR INFORMATION FORM 
Main: 
FAX: 
Toll-free: 
DATE & TIME OF REQUEST 
I 
MEMBER/ANALYST ASSIGNED 
RICS Control #: 
Rank: 
Received/Entered By: 
Last Name: 
Date: 
Time: 
Tax / SS#: 
REQUESTOR'S INFORMATION 
Agency Name and 
Investigation 
Child 
NY03030C9 
Command/Unit: 
Child Exploit T/F 
ORI: 
Type: 
Exploitation 
Workplace (Full Address): 
26 Federal Plaza, New York, NY 10278 
Last Name 
First Name: 
Ftankaitle: 
Detective 
Tax # NYPD Only: 
SSN: 
Date of Appointment: 
08/30/1993 
Office #: 
Fax A: 
Pager/Cell#: 
Pin: 
TZS/Pct. Of Occ.: 
CompIft: 
Case#: 
2017-212 
Conferred w/ Requestor Date: 
Time: 
Supervisor's Rank/Full Name: 
LT 
Phone Number: 
SUBJECT INFORMATION 
Last Name: 
Borgerson 
First Name: 
Scott 
Middle: 
G 
Aliases: 
DOB: 
Age: 
44 
Sex: 
M 
Race: 
W 
POB: 
Gang Name: 
Bldg# 
Street: 
Apt: 
City: 
State: 
ZIP Code: 
Tel# 
SSN# 
Driver License#: 
S 
State/Country: 
MA 
Arrest: 
FBI#: 
NYSID#: 
Other State SID#: 
BUSINESS LOCATION & FINANCIAL INFORMATION 
Business 
Bldg: 
Street: 
Name: 
City 
State: 
Zip Code 
Tel#: 
Last Name: 
First Name: 
(Circle One) 
Owner/Mgr/Employee 
Tax ID#: 
Financial Institution: 
Account Type: 
VEHICLE INFORMATION 
Plate it: 
State/Country: 
Year: 
Make: 
Model: 
No. Doors/Body Style: 
Color: 
Gray 
VIN#: 
 
REMARKS 
What have you (Requestor) done? 
What needs to be done by NYSIC personnel? 
I am requesting a CIAS search of the above named male for the past one year. 
EMAIL Request to NYSIC: ciu n csic.n . ov OR 
FAX Request to NYSIC: 
(You MUST call 
to verify that your FAX was received!) 
EFTA00038390
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