IDENTITY THEFT
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10 JOHNSTON COUNTY E - 911 COMMUNICATION NCIC ENTRY FORM Identity Theft Mandatory Fields AGENCY CASE DATA Originating Agency Name ______________________________________ Originating Agency Code ORI ____________________ __ Agency Case Number ____________________ __ Message Key __ ___________________ Notify Originating Agency ____________________ __ Caution Medical Condition _____________________ Linkage Agency Identifier ____________________ __ Linkage Case Number _____________________ Password ____________________ __ Date of Purge __ ___________________ Date of Theft ____________________ __ Message Key PERSON DATA Name _ _________________________________________________ Sex __ _______________ Race _ ________________ Height _________________ Weight _ ________________ Hair Color ___________ ______ Eye Color _____________ ____ Skin Tone _ ________________ Date of Birth _ ________ ________ Place of Birth _ ________________ Scars Marks and Tattoos _ __________________________________ Social Security Number __ _______________ Miscellaneous Number ______________________ FBI Number _ _____________________ Finger Print Classification ______________________ Identification Type _ _____________________ Linkage Agency Identifier Information Date ___________________________ NIC # _ _________________ __ _________ Officer _ __________________________ Operator ____________________ __ _______Page