New York State Intelligence Center Main:
FAX:
Latham, New York 12110 Toll-free:
REQUEST FOR INFORMATION FORM
DATE & TIME OF REQUEST I MEMBER/ANALYST ASSIGNED
RICS Control #: Rank:
Received/Entered By: Last Name:
Date: Time: Tax / SS#:
REQUESTOR'S INFORMATION
Agency Name and Investigation Child
NY03030C9 Command/Unit: Child Exploit T/F
ORI: Type: 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: LT Phone Number:
SUBJECT INFORMATION
Last Name: Maxwell First Name: Ghislaine Middle: N Aliases:
DOB: Age: 57 Sex: F Race: W POB: Gang Name:
Bldg# Street: Apt: City:
State: ZIP Code: Tel# SSN#
Driver License#: State/Country: FL Arrest:
FBI#: NYSID#: Other State SID#:
BUSINESS LOCATION & FINANCIAL INFORMATION
Business
Bldg: Street:
Name:
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
FAX Request to NYSIC: (You MUST call to verify that your FAX was received!)
EFTA00038389