Form SP-167 at a glance
What it is: Form SP-167 is the Criminal History Record Name Search Request: the Virginia State Police search the Central Criminal Records Exchange and report the results to the agent or individual authorized to receive same.
Who signs: Affidavit for Release of Information: the individual on whom the search is to be conducted signs, and the signature indicating consent must be notarized for the search to be conducted and mailed to the individual or authorized agent (if applicable). The signature of person making request must be signed by the authorized agent and notarized to receive the search results.
A filled-in Form SP-167 example: a name search on yourself for a domestic adoption
How to fill out Form SP-167, box by box
Purpose of this request
Under Purpose of this Request, check only one: Domestic Adoption, International Adoption, Visa (International Travel) or Other (please specify).
Name information to be searched
Name information to be searched: the name, race, sex, date of birth, and social security number on whom the criminal record name search is to be conducted.
Providing the social security number is voluntary; however, it is a screening tool that is used for this request to be processed in a more timely manner. Failure to provide this number may result in an inability to process this request due to multiple records with similar names and demographics.
Without this additional identifier, the form may be returned to the requestor unprocessed, and the applicant will be required to submit a set of fingerprints along with this request form to determine if this applicant has a criminal record.
Notary lines
The notary lines are: State of, County or City of, Subscribed and sworn to before me on (MM/DD/YYYY), My commission expires, My registration # is, and Signature of Notary Public.
Signature of person making request
Signature of person making request: As provided in Section 19.2-389, Code of Virginia, I hereby request the criminal history record of the individual named above and swear or affirm I have the consent of the individual to obtain their record and will not further disseminate the information received, except as provided by law.
Name and mailing address of the agency, individual or authorized agent
The name and complete mailing address of the individual, agency or authorized agent to receive the processed criminal record search must be completed.
Fees for service and method of payment
Under Fees for Service, indicate the fee that is submitted, based upon type of request.
Cost Structure and Types of Records Searches Available: Criminal History Record $15.00 per search of Criminal History Name File, and $20.00 for a combination criminal history and sex offender search (checked November 14, 2026). * Fees for volunteers with non-profit organizations: $8.00 criminal history search and $16.00 combination criminal history and sex offender search (checked November 14, 2026). To be entitled to reduced price, services must be on volunteer basis for a non-profit organization with a tax exempt number. Attach documentation to form which supports volunteer status and include organization's name, address, and the tax exempt identification number. Fees for volunteer of non-profit organizations must be accompanied with their tax exempt number. Method of payment (Note: Personal Checks Not Accepted): Business or Certified check or Money order (payable to Virginia State Police), or charge card: MasterCard or Visa. Mail the completed SP-167 “Criminal History Record Request” to: Virginia State Police Central Criminal Records Exchange - NF P. O. Box 85076 Richmond, Virginia 23261-5076 ATTN: NEW FORM.
More rules for Form SP-167
The form must be typed or neatly hand-printed.
Sources
[1] Form SP-167 (Revised 12-01-2012), Criminal History Record Name Search Request, Virginia State Police (the Official source link on this page).
