Accurate Biometrics phone 773-685-5699
4849 N Milwaukee Suite 101 fax 773-685-5433
Chicago, IL 60630 Web Site: www.accuratebiometrics.com
F.P. Tech: ________________ TCN:
Date Fingerprinted:
___________________________________________
UCIA
Thank you for choosing Accurate Biometrics for your fingerprinting needs.
PLEASE PROVIDE THE FOLLOWING INFORMATION (PLEASE PRINT CLEARLY)
Last name:
First name:
Middle Initial: Daytime Phone:
Date of Birth:
Sex: (circle one) Male Female
(circle one)
Race: White Black Hispanic Asian American Indian/Alaskan Other
REQUESTOR INFORMATION
Name: ___________ _______ _____Agency Name: ______________________
Street Address: ______________________________________________
City ________________________ State: _______ Zip Code: ______________
I, the undersigned, authorize Accurate Biometrics to capture and transmit my fingerprints and
above-noted demographic data to the Illinois State Police. I understand that the Illinois State
Police will return the results of the fingerprint search to the Requestor listed above.
Signature ___________________________________ Date ______________
(Do Not Write Below This LineFor Office Use Only)
State of Illinois Background Check
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