Form Sp 4 164 PDF Details

In the realm of public safety and personal verification, the SP 4-164 form issued by the Pennsylvania State Police stands as a vital document for those seeking to obtain criminal record checks within the state. Designed to cater to both individuals and non-criminal justice agencies, this form requires meticulous completion in ink, underlining its official nature. The submission process is underscored by a clear warning: all entries must be legible and accurately filled to avoid any delays or returns unprocessed. With response times extending to four weeks or more, the form also points users towards an online platform, promising quicker feedback. Payments, reflective of the requested check type, demand precision — requiring certified checks or money orders addressed to the "Commonwealth of Pennsylvania," underscoring the official and non-refundable nature of this transaction. The SP 4-164 form extends its utility across various sectors, from adoption and healthcare to education and volunteer work, showcasing its fundamental role in vetting processes. Notably, it emphasizes accessibility solely to the requester or their legal representative for the purpose of reviewing criminal history, thereby safeguarding personal information while facilitating a multitude of background checks. This meticulous approach, coupled with the legal caveat against misuse or falsification, reinforces the form's crucial position in ensuring public safety and personal verification within Pennsylvania.

QuestionAnswer
Form NameForm Sp 4 164
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namespa sp4 164 form, pa criminal form, sp4 164 criminal record form, pa criminal form fillable

Form Preview Example

SP 4-164 (2-2013)PENNSYLVANIA STATE POLICE

REQUEST FOR CRIMINAL RECORD CHECK

This form is to be completed in ink by the requester – (information will be mailed to the requester only). If this form is not legible or not properly completed, it will be returned unprocessed to the requester. A response may take four weeks or longer.

TRY OUR WEBSITE FOR A QUICKER RESPONSE

https://epatch.state.pa.us

NAME/

REQUESTER

ADDRESS

CITY/STATE/

ZIP CODE

CONTACT TELEPHONE NUMBER (INCLUDING AREA CODE)

 

 

 

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FOR CENTRAL REPOSITORY USE ONLY

CONTROL NUMBER

AFTER COMPLETION MAIL TO:

PENNSYLVANIA STATE POLICE CENTRAL REPOSITORY – 164 1800 ELMERTON AVENUE HARRISBURG, PA 17110-9758

1-888-QUERYPA (1-888-783-7972)

DO NOT SEND CASH OR PERSONAL

CHECK

CHECK ONE BLOCK

INDIVIDUAL/NONCRIMINAL JUSTICE AGENCY – ENCLOSE A CERTIFIED CHECK/MONEY ORDER IN THE AMOUNT OF $10.00, PAYABLE TO:

COMMONWEALTH OF PENNSYLVANIA

THE FEE IS NONREFUNDABLE

NOTARIZED INDIVIDUAL/NONCRIMINAL JUSTICE AGENCY – ENCLOSE A CERTIFIED CHECK/MONEY ORDER IN THE AMOUNT OF $15.00, PAYABLE TO:

COMMONWEALTH OF PENNSYLVANIA

THE FEE IS NONREFUNDABLE

FEE EXEMPT-NONCRIMINAL JUSTICE AGENCY – NO FEE

NAME/SUBJECT OF RECORD CHECK (FIRST)

(MIDDLE)

(LAST)

MAIDEN NAME AND/OR ALIASES

SOCIAL SECURITY NUMBER

DATE OF BIRTH (MM/DD/YYYY)

SEX

RACE

The Pennsylvania State Police response will be based on the comparison of the data provided by the requester

against the information contained in the files of the Pennsylvania State Police Central Repository only

FEES FOR REQUESTS - $10.00. NOTARIZED FEE REQUESTS - $15.00.

***MAKE ALL MONEY ORDERS PAYABLE TO: COMMONWEALTH OF PENNSYLVANIA ***

◄◄◄◄◄◄CHECK BOX THAT MOST APPLIES TO THE PURPOSE OF THIS REQUEST►►►►►►

REASON FOR REQUEST

INTERNATIONAL ADOPTION - INTERNATIONAL ADOPTION MUST BE NOTARIZED AND MAILED IN. ($15.00 FOR REQUEST)

ADOPTION (DOMESTIC)

ATTORNEY

BANKING

BAR ASSOCIATION

CHURCH

CHILD CARE

EDUCATION

ELDER CARE

EMERGENCY MANAGEMENT

EMPLOYMENT/SCREENING

FOSTER CARE

HEALTHCARE

HOUSING

INSURANCE LICENSE

MENTAL HEALTH

NURSE AID TRAINING

OTHER _________________

PASSPORT

PRIVATE INVESTIGATIONS

SOCIAL SERVICES

TENANT CHECK

VISA

VOLUNTEER AMBULANCE/FIREFIGHTER

VOLUNTEER

ACCESS & REVIEW - (NOT FOR EMPLOYMENT PURPOSES. MUST BE MAILED INTO THE CENTRAL REPOSITORY WITH A COPY OF A VALID GOVERNMENT ISSUED PHOTO ID, SEE TERMS & CONDITIONS)

AVAILABLE ONLY TO SUBJECT OF RECORD OR LEGAL REPRESENTATIVE WITH LEGAL AFFIDAVIT AND REQUIRED COPY OF GOVERNMENT

PHOTO ID ATTACHED FOR THE PURPOSE OF REVIEWING YOUR CRIMINAL HISTORY.

WARNING: 18 Pa.C.S. 4904(b) UNDER PENALTY OF LAW - MISIDENTIFICATION OR FALSE STATEMENTS OF IDENTITY TO OBTAIN CRIMINAL HISTORY INFORMATION OF ANOTHER IS PUNISHABLE AS AUTHORIZED BY LAW.

Homeland Security is Everyone’s Responsibility - Pennsylvania Terrorism Tip Line 1-888-292-1919

How to Edit Form Sp 4 164 Online for Free

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In the MAIDEN NAME ANDOR ALIASES, SOCIAL SECURITY NUMBER, DATE OF BIRTH MMDDYYYY, SEX, RACE, The Pennsylvania State Police, FEES FOR REQUESTS NOTARIZED FEE, INTERNATIONAL ADOPTION, REASON FOR REQUEST, ADOPTION DOMESTIC, EMPLOYMENTSCREENING, PASSPORT, ATTORNEY, FOSTER CARE, and PRIVATE INVESTIGATIONS field, note your data.

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