PERSON WANTED SUPPLEMENTAL
This PDF document may not meet current accessibility standards (WCAG 2.1 AA) and may not be fully usable with assistive technologies.
If you require access to the information in a more accessible format, please e-mail webstaff@johnstonnc.gov and we will provide an alternative version as soon as possible. A machine-generated text version is also available below.
We apologize for any inconvenience and appreciate your understanding as we work toward full accessibility compliance.
If the document does not display above, download the PDF.
Text version (machine-generated from the PDF)
10 JOHNSTON COUNTY E - 911 COMMUNICATION NCIC ENTRY FORM Wanted Person Supplemental Form AGENCY CASE DATA Originating Agency Name ____________________________________________________________________ Originating Agency Code ORI __ _____________________________ Message Key __________________ RECORD IDENTIFYING DATA NCIC Number NIC _______________________________________________________ Agency Case Number OCA _________________________________________________ Name NAM _________________________________________________ ____________ SUPPLEMENTAL AGENCY CASE DATA Caution and Medical Conditions CMC _________________________________________________________________ SUPPLEMENTAL PERSON DATA Alias AKA _______________________________________________________________________________________ Date of Birth DOB ___________________________ Citizenship CTZ ____________________________ __ Alias AKA _______________________________________________________________________________________ Date of Birth DOB ___________________________ Citizenship CTZ ______________________________ Alias AKA _______________________________________________________________________________________ Date of Birth DOB ___________________________ Citizenship CTZ ______________________________ Scars Marks and Tattoos SMT _______________________________________________________________________ Social Security Number SOC ______________________ _________________________ ______________________ Miscellaneous Number MNU _______________________Type ______ _______________________Type ______ _______________________Type ______ License Number OLN _____________________________ State ______________ Year ___________________ License Number OLN _____________________________ State ______________ Year ___________________ License Number OLN _____________________________ State ______________ Year ___________________ SUPPLEMENTAL PERSON ADDRESS DATA Street Number SNU ______________________ Street Name __________________________________________ City Name _______________________________ County _______________________________________________ State STA ______________ Zip Code ZIP ___________________ Address Type ADD _________________ Date of Documented Address DDA _____________________________ Street Number SNU ______________________ Street Name __________________________________________ City Name _______________________________ County _______________________________________________ State STA ______________ Zip Code ZIP ___________________ Address Type ADD _________________ Date of Documented Address DDA _____________________________ Street Number SNU ______________________ Street Name __________________________________________ City Name _______________________________ County _______________________________________________ State STA ______________ Zip Code ZIP ___________________ Address Type ADD _________________ Date of Documented Address DDA _____________________________PageJOHNSTON COUNTY E - 911 COMMUNICATION NCIC ENTRY FORM Wanted Person Supplemental Form SUPPLEMENTAL VEHICLE DATA Vehicle ID Number VIN ____________________________________________________________________________ Make VMA ___________________________________ Model VMO __________________________________ Style VST ____________________________________ Color VCO ___________________________________ Year of Manufacturer VYR _______________________ Owner Applied Number OAN ____________________ Vehicle ID Number VIN ____________________________________________________________________________ Make VMA ___________________________________ Model VMO __________________________________ Style VST ____________________________________ Color VCO ___________________________________ Year of Manufacturer VYR _______________________ Owner Applied Number OAN ____________________ Vehicle ID Number VIN ____________________________________________________________________________ Make VMA ___________________________________ Model VMO __________________________________ Style VST ____________________________________ Color VCO ___________________________________ Year of Manufacturer VYR _______________________ Owner Applied Number OAN ____________________ SUPPLEMENTAL LICENSE PLATE DATA License Plate LIC ___________________________________ Year ___________________________________ License Plate LIC ___________________________________ Year ___________________________________ License Plate LIC ___________________________________ Year State _______________________________ Type _______________________________ State _______________________________ Type _______________________________ State _______________________________ Type SUPPLEMENTAL IMAGE DATA Image NIC Number IMN _____________________________ Image Type IMT ___________________________ Test Indicator Yes No ____________________________ Information Date ___________________________ Officer ___________________________ NIC # _____________________________ Operator _____________________________Page