◆ SpookStack

Federal bureau of investigation, ynited $tates pepartment of JustiCe WA$HINGTON, D.C. 20537 SUCH DISCLOSURE IS MANOATORY OR VOLUNTARY, BASI$ OF AUTHORITY FOR SUCH SOLICITATION, AND USES WHICH WILL BE MADE CF IT. JuveniLe fingerpAint DATE OFARREST ORI SUBMISSION YES MM DD AA CONTRIEUTOR CAFBILAOO FB1 ADORESS LOS ANGELES, CA TreaT AS ADULt YES REPLY DESIRED? SENDCOPY TO: Date of offense PLACE OF BIATH (STATE OR COUNTRY) COUNTRY OF CITIZENSHIP (ENTER OR MM DD YY MiSCELLAnEOUS NUmBERS SCARS,MARKS,TATTOOS,AND AMPUTATIONS RESIDENCE/COMPLETE ADDRESS CiTY STATE OFFICIAL TAKING FINGERPRINTS LOCAL IDENTIFICATION/REFEAENCE PHOTO AVAILABLE YEs (NAME OR NUMBER PALM PRINTS TAKEN? YES EMPLOYER: If u.s. goveanment. indicate specific Agency. OCCUPATION IF MILITARY,LIST BRANCH OF SERVICE AND SERIAL NO. CHARGE/CITATION DISPOSITION 1. 1. 2. 2. 3 3 ADDITIONAL ADDITIONAL ADDITIONAL INFORMATION/BASIS FOR CAUTION StATe Bureau stAmp US.GPO:1998 432-177/60051 FD-249{Rev.t2-1-94}