Form DPS-0846-C "Criminal History Record Request Form" - Connecticut

What Is Form DPS-0846-C?

This is a legal form that was released by the Connecticut Department of Emergency Services and Public Protection - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2017;
  • The latest edition provided by the Connecticut Department of Emergency Services and Public Protection;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DPS-0846-C by clicking the link below or browse more documents and templates provided by the Connecticut Department of Emergency Services and Public Protection.

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Download Form DPS-0846-C "Criminal History Record Request Form" - Connecticut

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STATE OF CONNECTICUT
DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION
Division of State Police
State Police Bureau of Identification
STATE OF CONNECTICUT
CRIMINAL HISTORY RECORD REQUEST FORM
(PLEASE TYPE OR PRINT CLEARLY)
Check Type of Background Search Requested:
(
) CT Only search by Name/Date of Birth-$36.00
(will only provide existence of a record and not actual record)
(
) CT Only Criminal Conviction History Record Search-$75.00
(Name/DOB Search will provide a copy only if a record exists)
(
) CT Only Criminal Conviction History Record searched by Fingerprint-$75.00*
*Fingerprinting completed at a Connecticut State Police location - $15.00
Name of Requester:____________________________________Date:____________________
Requester Address:____________________________________________________________
City:___________________State:______Zip:________Phone Number:___________________
E-Mail Address:________________________________________________________________________
(NOTE: If e-mail address is provided, results will be sent solely via e-mail)
1. Print full name and date of birth, maiden or alias names for each subject requested.
2. If a fingerprinted criminal history record check is required submit a Fingerprint card along with
this form.
3. Enclose a Check or Money Order for the applicable amount made payable to:
“Treasurer-State of CT”
4. If you are requesting more than one name please submit one check for the total dollar amount of
all subjects requested. A separate form will be required for each search requested.
5. Mail Request with Check or Money Order to:
DESPP-SPBI
1111 Country Club Road
Middletown, CT 06457-2389
___________________________________________________________________/___/_______
Subject’s Last Name
First
Middle
Date of Birth
List any alias or maiden names and dates of births used:
______________________________________________________________________________________________
The result of this search is based on name and date of birth or fingerprint card submission and contains State
of Connecticut criminal conviction history record information ONLY. Please be advised that the criminal
history record information may change daily due to erasures, corrections, pardons or other modifications to
individual criminal history record information, the Department of Emergency Services and Public Protection
(DESPP) cannot guarantee the accuracy of the information except with respect to the date the information is
disclosed or obtained. DESPP and the State of Connecticut are not responsible for any errors or omissions
resulting from subsequent dissemination of this data. The subject and/or requester assumes all liability in the
use of data obtained from this database.
**A COPY OF THIS FORM MAY BE USED**
Phone: (860) 685-8480 Fax: (860) 685-8361
1111 Country Club Road
Middletown, CT 06457-2389
An Affirmative Action / Equal Opportunity Employer
DPS-0846-C (Rev. 12/01/17)
Form Available @ www.ct.gov/despp
STATE OF CONNECTICUT
DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION
Division of State Police
State Police Bureau of Identification
STATE OF CONNECTICUT
CRIMINAL HISTORY RECORD REQUEST FORM
(PLEASE TYPE OR PRINT CLEARLY)
Check Type of Background Search Requested:
(
) CT Only search by Name/Date of Birth-$36.00
(will only provide existence of a record and not actual record)
(
) CT Only Criminal Conviction History Record Search-$75.00
(Name/DOB Search will provide a copy only if a record exists)
(
) CT Only Criminal Conviction History Record searched by Fingerprint-$75.00*
*Fingerprinting completed at a Connecticut State Police location - $15.00
Name of Requester:____________________________________Date:____________________
Requester Address:____________________________________________________________
City:___________________State:______Zip:________Phone Number:___________________
E-Mail Address:________________________________________________________________________
(NOTE: If e-mail address is provided, results will be sent solely via e-mail)
1. Print full name and date of birth, maiden or alias names for each subject requested.
2. If a fingerprinted criminal history record check is required submit a Fingerprint card along with
this form.
3. Enclose a Check or Money Order for the applicable amount made payable to:
“Treasurer-State of CT”
4. If you are requesting more than one name please submit one check for the total dollar amount of
all subjects requested. A separate form will be required for each search requested.
5. Mail Request with Check or Money Order to:
DESPP-SPBI
1111 Country Club Road
Middletown, CT 06457-2389
___________________________________________________________________/___/_______
Subject’s Last Name
First
Middle
Date of Birth
List any alias or maiden names and dates of births used:
______________________________________________________________________________________________
The result of this search is based on name and date of birth or fingerprint card submission and contains State
of Connecticut criminal conviction history record information ONLY. Please be advised that the criminal
history record information may change daily due to erasures, corrections, pardons or other modifications to
individual criminal history record information, the Department of Emergency Services and Public Protection
(DESPP) cannot guarantee the accuracy of the information except with respect to the date the information is
disclosed or obtained. DESPP and the State of Connecticut are not responsible for any errors or omissions
resulting from subsequent dissemination of this data. The subject and/or requester assumes all liability in the
use of data obtained from this database.
**A COPY OF THIS FORM MAY BE USED**
Phone: (860) 685-8480 Fax: (860) 685-8361
1111 Country Club Road
Middletown, CT 06457-2389
An Affirmative Action / Equal Opportunity Employer
DPS-0846-C (Rev. 12/01/17)
Form Available @ www.ct.gov/despp