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
Command/Unit:
NY03030C9
ORI: | Child
Investigation
Child Exploit T/F
Type:
Exploitation |
| Workplace (Full Address):
26 Federal Plaza, New York, NY 10278 | |
| First Name:
Last Name | Ftankaitle:
Detective |
| Tax # NYPD Only:
SSN: | Date of Appointment:
08/30/1993 |
| Office #:
Fax A: | Pin:
Pager/Cell#: |
| TZS/Pct. Of Occ.:
CompIft:
Case#:
2017-212 | Conferred w/ Requestor Date:
Time: |
| LT
Supervisor's Rank/Full Name:
Phone Number: | |
| SUBJECT INFORMATION | |
| First Name:
Last Name:
Borgerson
Scott | Middle:
G
Aliases: |
| M
W
DOB:
Age:
44
Sex:
Race: | POB:
Gang Name: |
| Apt:
City:
Bldg#
Street: | |
| ZIP Code:
Tel#
State: | SSN# |
| Driver License#:
MA
Arrest:
State/Country:
S | |
| FBI#:
NYSID#: | Other State SID#: |
| BUSINESS LOCATION & FINANCIAL INFORMATION | |
| Business
Bldg:
Street:
Name: | |
| City
State: | Zip Code
Tel#: |
| First Name:
Last Name: | (Circle One)
Owner/Mgr/Employee |
| Tax ID#:
Financial Institution:
Account Type: | |
| VEHICLE INFORMATION | |
| Plate it:
State/Country: | Make:
Model:
Year: |
| Color:
No. Doors/Body Style: | 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 male for the past one year. | |
| | |
| | |
| EMAIL Request to NYSIC: ciu n csic.n . ov OR | |
| FAX Request to NYSIC:
(You MUST call
to verify that your FAX was received!) | |
New York State Intelligence Center
Latham, New York 12110
### REQUEST FOR INFORMATION FORM
| DATE & TIME OF REQUEST | | | | MEMBER/ANALYST ASSIGNED | | | | |
|------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------|-------------|-------------------|-------------------------|------------------------------|------------------------|-----------------|--|
| RICS Control #: | | | Rank: | | | | | |
| Received/Entered By: | | | | Last Name: | | | | |
| Date: | Time: | | Tax / SS#: | | | | | |
| REQUESTOR'S INFORMATION | | | | | | | | |
| Agency Name and
ORI: | NY03030C9 | | Command/Unit: | | Child Exploit T/F | Investigation
Type: | Sex Trafficking | |
| Workplace (Full Address):
26 Federal Plaza, New York, NY 10278 | | | | | | | | |
| Last Name | | First Name: | | | | Rank/Title: | Detective | |
| Tax # NYPD Only: | SSN: | | | | Date of Appointment: | | 08/30/1993 | |
| Office #: | Fax #: | | Pager/Cell#: | | | Pin: | | |
| TZS/Pct. Of Occ.: | Compl#: | Case#: | 31E-NY-
302870 | | Conferred w/ Requestor Date: | | Time: | |
| LT
Supervisor's Rank/Full Name:
Phone Number:
- | | | | | | | | |
| SUBJECT INFORM TION | | | | | | | | |
| Last Name: | First Name: | | Middle: | | Aliases: | | | |
| DOB:
Age: | Sex | Race: | POB: | | | Gang Name: | | |
| Street:
Bldg# | | | Apt: | | City: | | | |
| State:
Code: | | Tel# | | | SSN# | | | |
| Driver License#: | State/Country: | | | Arrest: | | | | |
| FBI#: | Other State SID#:
NYSID/4: | | | | | | | |
| BUSINESS LOCATION & FINANCIAL INFORMATION | | | | | | | | |
| Business
Name: | Bldg: | | Street: | | | | | |
| City | | State: | | Zip Code | | Tel#: | | |
| Last Name: | First Name: | | | | (Circle One) | Owner/Mgr/Employee | | |
| Tax ID/4: | Financial Institution:
Account Type: | | | | | | | |
| VEHICLE INFORMATION | | | | | | | | |
| Plate #: | State/Country: | MA | Year: | 19 | Make: | CHEV | 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 the assistance of the NYSP regarding a CIAS check as well as NYSP , LPR's,. | | | | | | | | |
| | | | | | | | | |
| | | | | | | | | |
| | | | | | | | | |
| EMAIL Request to NYSIC: ciu6i)nvsic.nv.eov OR | | | | | | | | |
EFTA00038392