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EFTA00005774
DMV Photo
Subject Information
Name:
ClientiD:
Case Number: SI
DMV Transaction Number: 1069006
DMV Transaction Date/Time: 2019-06-05 18:36:18:690
EFTA00005775
Last updated: 01108/2017
Request for NYS DMV P OTO IMAGE
To: New York Ops Center (NYOC)
[office: 212-384-2921;fax: 212-384-4073 or 4074)
Requestor Email: Sq t ad: e--;
Ir***sh*******—Ir
1) Name & Rank of Requestor.
MUST be Special Agent or other 3,
2) Name & Rank of Supervisor:
MUST be Supervisory Special Agent or of
--n.freevisac
e support personnel
3) Subject Name:
4) DMV Client ID # (Nine Digits):
If nn Client ID available, include Subject's D rB
role one):
ant Investigation Witness Investigation Missing Person Investigation
6) Exigent Circums ances (if applicable)*:
Comments
7) Case number:
8) Phone number of Requestor:
The requestor acknowledges that the mquested image cannot be used as filjgg in a phot 1'y, the OW photo may only be used
in an any if the subject of the DMV photo is the subject in the photo array. A new request it. r a photo image must be made for any
unrelated criminal investigation. The digital image obtained will not be saved in a database stored in any manner for secondary or
subsequent use unrelated to the original investigation.
I hereby certify that the above-requested DMV Photo Image b relevant to as a Investigation and that, to the best of
my knowledge, the subject of interest possesses a driver's II e, learner's permit or non ;river identtlleatIon card issued the
New York State DA J and acknowledge hat I r oat was for an hope 1 ... Me jurrpose I may be subject to
/,
ature) Date
*When the exigent circumstances exception applies, the "Comments" section must identify the t f investigation and explain the
urgency. In addition, the "Request for DNS/ Photo Imago — Exigent Cncwmtances" form must pitted and retained by the
requesting agency.
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