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.
| Question | Answer |
|---|---|
| Form Name | Sp 167 Form |
| Form Length | 3 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 45 sec |
| Other names | virginia state form sp 167, virginia criminal history form form, virginia criminal history record form, sp 167 criminal history form |
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
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
$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
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
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/ |
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
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
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 |
|
organizations must be accompanied with their tax exempt number. |
METHOD OF PAYMENT: |
Indicate method of payment |
Mail the Completed
Virginia State Police
Central Criminal Records Exchange – NF
P.O. Box 85076
Richmond, Virginia
Page 2
Instructions For Requesting a Search of the “Sex Offender and Crimes Against Minors Registry”
In accordance with Section
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
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 |
|
|
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 |
$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
$8.00 for each name search of the Sex Offender Registry conducted for individuals |
|
SEX OFFENDER |
volunteering for a |
|
documentation explaining the purpose of the search is for volunteering services for a |
|
|
|
organization, address and the |
Page 3