SECURITIES SINGLE AND GROUP
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10 JOHNSTON COUNTY E - 911 COMMUNICATION NCIC ENTRY FORM Securities Single Group Mandatory Fields SINGLE AGENCY CASE DATA Originating Agency Name ________ ______________________________ Originating Agency Code ORI _ _____________________ Agency Case Number _ _____________________ Notify Originating Agency __________ ____________ Date of Theft __ ___________________ Linkage Agency Identifier _ _____________________ Linkage Case Number _____________________ GROUP AGENCY _____________________ CASE DATA Consecutively Serialized Originating Agency Name ___ ___________________________________ Originating Agency Code ORI _ _____________________ Agency Case Number _ _____________________ Notify Originating Agency _____ _________________ Date of Theft _____________________ Linkage Agency Identifier ______________________ Linkage Case Number _____________________ This section is mandatory with the single or the group _____________________ SECURITY DATA Type __ ___________________ Denomination _ ____________________ Serial Number _____________________ Issuer _____________________ Issue Date _____________________ Owner __ ____________________________ ___________________ Social Security Number _________________ _____ Ransom Money Indicator _ ____________________ _ Information Date ___ ________________________ NIC # ___________________________ Officer _ __________________________ Operator ___________________________Page