Sp 167 Form PDF Details

The Sp 167 form is a document used to report or ask for information about a deceased individual. This form can be used by individuals or organizations, such as funeral homes, to report the death of an individual and provide information about them. The Sp 167 form is also used to request information about a deceased individual from another party. It is important to fill out this form accurately and completely in order to provide the best possible information about the deceased individual.

The table includes specifics of the sp 167 form. It's going to give you the estimated time it'd take you to fill out the form and several other details.

QuestionAnswer
Form NameSp 167 Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesvirginia state form sp 167, virginia criminal history form form, virginia criminal history record form, sp 167 criminal history form

Form Preview Example

SP-167 (Revised 12-01-2012)

CRIMINAL HISTORY RECORD NAME SEARCH REQUEST

PURPOSE OF THIS REQUEST (Check only one):

DOMESTIC ADOPTION

INTERNATIONAL ADOPTION

COUNTRY

 

 

VISA (INTERNATIONAL TRAVEL)

 

OTHER (please specify)

 

 

 

 

 

 

 

 

 

 

NAME INFORMATION TO BE SEARCHED:

 

 

 

 

 

LAST NAME

 

FIRST NAME

MIDDLE NAME

MAIDEN NAME

RACE

SEX DATE OF BIRTH

/

/

(MM/DD/YYYY)

SOCIAL SECURITY NUMBER

AFFIDAVIT FOR RELEASE OF INFORMATION:

I hereby give consent and authorize the Virginia State Police to search the files of the Central Criminal Records Exchange for a criminal history record and report the results of such search to the agent or individual authorized in this document to receive same.

State of

County

Signature

City of

 

; to wit: Subscribed and sworn to before me on:

(MM/DD/YYYY)

My commission expires:

 

My registration # is:

Signature of Notary Public

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.

State of

County

Signature of Individual Making Request

City of

 

; to wit: Subscribed and sworn to before me on:

(MM/DD/YYYY)

My commission expires:

 

My registration # is:

Signature of Notary Public

NAME AND MAILING ADDRESS OF AGENCY, INDIVIDUAL OR AUTHORIZED AGENT MAKING REQUEST:

Mail Reply To:

NAME

ATTENTION

ADDRESS

CITY

STATE ZIP CODE

FEES FOR SERVICE:

* FEES For Volunteers with Non-Profit Organizations:

$15.00 CRIMINAL HISTORY SEARCH

$20.00 COMBINATION CRIMINAL HISTORY & SEX OFFENDER SEARCH

$8.00 CRIMINAL HISTORY SEARCH

$16.00 COMBINATION CRIMINAL HISTORY & SEX OFFENDER SEARCH

*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.

METHOD OF PAYMENT: (Note: Personal Checks Not Accepted)

Business or Certified check or Money order (payable to Virginia State Police)

CHARGE CARD:

MasterCard

 

OR

Visa

 

Account Number:

 

-

-

-

 

Expiration:

/

Signature of Cardholder:

 

 

 

 

 

 

 

Virginia State Police Charge Account Number:

 

 

 

Mail Request To:

Virginia State Police

Central Criminal Records Exchange – NF

P. O. Box 85076

Richmond, Virginia 23261-5076

ATTN: NEW FORM

FOR STATE POLICE USE ONLY – DO NOT WRITE BELOW THIS LINE

Response based on comparison of name information submitted in request against a master name index maintained in the Central Criminal Records Exchange only.

No Conviction Data – Does Not Preclude the Existence of an Arrest Record

No Criminal Record – Name Search Only

No Criminal Record – Fingerprint Search

No Sex Offender Registration Record

Criminal Record Attached

Purpose code:

C

N

O

Date:

 

By CCRE/

SP-167 (Revised 12-01-2012)

CRIMINAL HISTORY RECORD NAME SEARCH REQUEST

INSTRUCTIONS FOR COMPLETING THE CRIMINAL HISTORY REQUEST FORM

Pay By: Certified Check/Money Order or Business check made payable to “Virginia State Police”

OR we accept VISA and MasterCard

Personal Checks Not Accepted

Effective November 1, 2010, the public is hereby placed upon notice that

returned checks or dishonored money orders and/or credit card payment denials will incur a handling fee of $50 in addition to the amount of the original payment.

Requesting goods or services will be deemed to be acceptance of these terms.

Code of Virginia §2.2-4805.

Discard these Instructions Prior to Submitting to State Police

Refer to Page 2 of these Form Instructions for Pricing Structure and Types of Name Searches Available

If you are interested in obtaining a name search of the “Sex Offender and Crimes

Against Minors Registry,” refer to the instructions on page 2 of this form.

The Form Must be TYPED OR NEATLY HAND-PRINTED.

Complete the Criminal History Record Request by following these instructions:

***

PURPOSE OF THIS REQUEST:

Primary reason for request.

NAME INFORMATION TO BE SEARCHED:

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. Social Security Numbers provided will be used to help identify the proper record and

 

will be used for no other purpose.

AFFIDAVIT FOR RELEASE OF

Individual’s signature on which the search is to be conducted. The signature indicating

INFORMATION:

consent must be notarized for the search to be conducted and mailed to the individual or

 

authorized agent (if applicable).

SIGNATURE OF PERSON MAKING REQUEST:

Affidavit must be signed by authorized agent and notarized to receive the search results.

NAME AND MAILING ADDRESS OF AGENCY,

Name and complete mailing address of the individual, agency or authorized agent to receive

INDIVIDUAL OR AGENT MAKING REQUEST:

processed criminal record search must be completed.

FEES FOR SERVICE:

Indicate fee that is submitted, based upon type of request. Fees for volunteer of non-profit

 

organizations must be accompanied with their tax exempt number.

METHOD OF PAYMENT:

Indicate method of payment

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

Page 2

SP-167 (Revised 12-01-2012)

Instructions For Requesting a Search of the “Sex Offender and Crimes Against Minors Registry”

In accordance with Section 9.1-9009.1-918, Code of Virginia, the Central Criminal Records Exchange of the Virginia Department of State Police is responsible for maintaining the above captioned Registry containing name, personal descriptive/conviction information and photographs of individuals convicted of specific sex offenses. The law also provides for the dissemination of sex offender registrations for the following purpose: Child/adult care, child minding, public/child protection, daycare services, volunteering services or employment. To request an inquiry of the Registry, SP-266 “Sex Offender and Crimes Against Minors Registry” name search forms may be obtained by downloading from the Virginia State Police website: http://www.vsp.virginia.gov.

There are two classifications of sex offenders: the sex offender and violent sex offender. A single name search can be conducted to determine if a person is convicted of a violent or sex offense by completing and SP-266 form. Violent sex offenders can be searched on the Virginia State Police website: Virginia State Police Sex Offender and Crimes Against Minors Registry http://sex-offender.vsp.virginia.gov/sor/.

Cost Structure and Types of Records Searches Available

***

CRIMINAL HISTORY RECORD

$15.00 per search of Criminal History Name File.

COMBINATION CRIMINAL HISTORY/SEX

$20.00 for a COMBINATION criminal history record name search conducted and a

OFFENDER REGISTRY

Sex Offender and Crimes Against Minors name search.

COMPLETE SEX OFFENDER REGISTRY

$15.00 per search of the Sex Offender Registry only through the submission of an

 

SP-266 “Sex Offender and Crimes Against Minors” name search request form.

VIOLENT SEX OFFENDERS

No Charge for searches conducted of violent offender registrations ONLY through

 

the Virginia State Police website: Virginia State Police Sex Offender and Crimes

 

Against Minors Registry http://sex-offender.vsp.virginia.gov/sor/.

NON-PROFIT ORGANIZATION COMBINATION CRIMINAL HISTORY/SEX OFFENDER REGISTRY

$16.00 for a COMBINATION criminal history record name search conducted for a “Criminal History Record Name Search” and “Sex Offender and Crimes Against Minors.” The purpose of this search is for volunteering services for a non-profit organization. The SP-167 must be submitted attached to documentation explaining the purpose of the search is for volunteering services for a non-profit organization. The documentation must include the name of the organization, address and the tax- exempt identification number of the organization.

NON-PROFIT ORGANIZATION COMPLETE

$8.00 for each name search of the Sex Offender Registry conducted for individuals

SEX OFFENDER

volunteering for a non-profit organization. The SP-167 must be submitted attached to

 

documentation explaining the purpose of the search is for volunteering services for a

 

non-profit organization. The documentation must include the name of the

 

organization, address and the tax-exempt identification number of the organization.

Page 3

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