New York State Intelligence Center
Latham, New York 12110
## REQUEST FOR INFORMATION FORM
| DATE & TIME OF REQUEST | MEMBER/ANALYST ASSIGNED
I | | | | |
|-----------------------------------------------------------------------------------|------------------------------|--------------|---------------------------------------------|-----------------------|--|
| RICS Control #: | | Rank: | | | |
| Received/Entered By: | | Last Name: | | | |
| Date:
Time: | | Tax / SS#: | | | |
| REQUESTOR'S INFORMATION | | | | | |
| Agency Name and
NY03030C9
ORI: | Command/Unit: | | Investigation
Child Exploit T/F
Type: | Child
Exploitation | |
| Workplace (Full Address):
26 Federal Plaza, New York, NY 10278 | | | | | |
| Last Name | First Name: | | Ftankaitle: | Detective | |
| Tax # NYPD Only:
SSN: | | | Date of Appointment: | 08/30/1993 | |
| Office #:
Fax A: | | Pager/Cell#: | Pin: | | |
| TZS/Pct. Of Occ.:
CompIft: | Case#:
2017-212 | | Conferred w/ Requestor Date: | Time: | |
| Supervisor's Rank/Full Name:
Phone Number:
LT | | | | | |
| SUBJECT INFORMATION | | | | | |
| First Name:
Last Name:
Maxwell | Ghislaine | Middle: | Aliases:
N | | |
| 57
Sex:
DOB:
Age: | F
Race:
W
POB: | | Gang Name: | | |
| Street:
Apt:
City:
Bldg# | | | | | |
| State:
ZIP Code: | Tel# | | SSN# | | |
| Arrest:
Driver License#:
State/Country:
FL | | | | | |
| FBI#: | NYSID#: | | Other State SID#: | | |
| BUSINESS LOCATION & FINANCIAL INFORMATION | | | | | |
| Business
Name: | Street:
Bldg: | | | | |
| City | State: | Zip Code | Tel#: | | |
| Last Name: | First Name: | | (Circle One) | Owner/Mgr/Employee | |
| Tax ID#:
Financial Institution:
Account Type: | | | | | |
| VEHICLE INFORMATION | | | | | |
| Plate #:
State/Country: | | Year: | Make: | Model: | |
| No. Doors/Body Style: | Color: | Gray | VIN#: | | |
| REMARKS | | | | | |
| What have you (Requestor) done? | | | | | |
| What needs to be done by NYSIC personnel? | | | | | |
| I am requesting a CIAS search of the above named female for the past one year. | | | | | |
| | | | | | |
| | | | | | |
| EMAIL Request to NYSIC:
OR | | | | | |
| to verify that your FAX was received!)
FAX Request to NYSIC:
(You MUST call | | | | | |