San Diego County
SHERIFF’S DEPARTMENT
(12/
20)
REQUEST FOR TIER NOTIFICATION LETTER
Last Name
First Name
Middle Name
Suffix
Alias Last Name
First Name
Middle Name
Suffix
_____
_______
_______
_______
( )
( )
Height
Weight
Hair color
Eye color
Home Phone
Cell Phone
Place of Birth
Driver's Lic # / State ID #
DL State
Expiration Date
Social Security Number
___________________________
CII # (on registration card)
RESIDENCE INFORMATION
Transient
Location(s) Frequented by Transient:
Single Family Residence Apartment / Condo Hotel / Motel Other :
Street Address
Apt / Unit
City
State
Zip Code
Registrant Signature
Date
___ I would like to pick up the letter Tuesday or Wednesday between 8:00-12:00
___ Please mail the letter to above address
___ Please mail the letter to ___________________________________________________________________________
________________________________________________________________________________________________
___ Please e-mail letter to _____________________________________________________________________________
FOR OFFICE USE ONLY
RECEIVED BY _________________________________________________ DATE _____________________
LETTER COMPLETED BY ________________________________________ DATE _____________________
LETTER WAS PICKED UP __________ MAILED _________ E-MAILED _______
DATE_____________________
click to sign
signature
click to edit