Form FD-249 Arrest and Institution Fingerprint Card

FEDERAL BUREAU OF INVESTIGATION, UNITED STATES DEPARTMENT OF JUSTICE
CRIMINAL JUSTICE INFORMATION SERVICES DIVISION,CLARKSBURG, WV 26306

1110-0046

The FBI's acquisition, preservation, and exchange of identification information is generally authorized under 28 USC 534. This FD-249 is to be used for criminal justice purposes, such as incident to arrests and
incarcerations. The Applicant form (FD-258) contains applicable Paperwork Reduction Act and Privacy Act notices and should be used for noncriminal justice purposes. “A Social Security Account Number (SSAN)
is helpful to keep records accurate because other people may have the same name and birth date. Pursuant to the Federal Privacy Act of 1974 (5 USC 552a), any Federal, State, or local government agency which
requests an individual to disclose his/her SSAN is responsible for informing the person whether disclosure is mandatory or voluntary, by what statutory or other authority the SSAN is solicited, and
what uses will be made of it..” FD-249 (Rev. 3-1-10)
JUVENILE FINGERPRINT

ORI

DAT E O F A R R E S T

SUBMISSION

YES

T R E AT A S A D U LT

YES

MM

DD

YY

C O N T R I B U TO R
ADDRESS
R E P LY

YES

DESIRED?
S E N D C O P Y TO :

DAT E O F O F F E N S E

(ENTER ORI)

MM

MISCELLANEOUS NUMBERS

O F F I C I A L TA K I N G F I N G E R P R I N T S

P L AC E O F B I RT H ( S TAT E O R C O U N T RY )
DD

C O U N T RY O F C I T I Z E N S H I P

YY

S C A R S , M A R K S , TAT TO O S , A N D A M P U TAT I O N S

RESIDENCE/COMPLETE ADDRESS

CITY

S TAT E

L O C A L I D E N T I F I C AT I O N / R E F E R E N C E

P H OTO AVA I L A B L E ?

YES

PA L M P R I N T S TA K E N ?

YES

(NAME OR NUMBER)

E M P L OY E R :

I F U. S . G OV E R N M E N T, I N D I C AT E S P E C I F I C AG E N C Y.

O C C U PAT I O N

I F M I L I TA RY, L I S T B R A N C H O F S E RV I C E A N D S E R I A L N O.

C H A R G E / C I TAT I O N
1.

DISPOSITION
1.

2.

2.

3.

3.

ADDITIONAL

ADDITIONAL

A D D I T I O N A L I N F O R M AT I O N / B A S I S F O R C AU T I O N

S TAT E B U R E AU S TA M P

LEAVE BLANK

CRIMINAL

LEAVE BLANK

(STAPLE HERE)
STATE USAGE
NFF SECOND
SUBMISSION

FD-249 (Rev. 3-1-10)

APPROXIMATE CLASS

STATE USAGE

AMPUTATION

SCAR

LAST NAME, FIRST NAME, MIDDLE NAME, SUFFIX

SIGNATURE OF PERSON FINGERPRINTED

SOCIAL SECURITY NO.

LEAVE BLANK

ALIASES/MAIDEN
LAST NAME, FIRST NAME, MIDDLE NAME, SUFFIX

FBI NO.

R. THUMB

6. L THUMB

STATE IDENTIFICATION NO.

DATE OF BIRTH

2. R. INDEX

3. R. MIDDLE

4. R. RING

5. R. LITTLE

7. L. INDEX

8. L. MIDDLE

9. L. RING

10. L. LITTLE

LEFT FOUR FINGERS TAKEN SIMULTANEOUSLY

L. THUMB

MM

DD

R. THUMB

YY

SEX

RACE

HEIGHT

WEIGHT

RIGHT FOUR FINGERS TAKEN SIMULTANEOUSLY

EYES

HAIR