"Service Cover Sheet and Ncic Information Form" - Kansas

Service Cover Sheet and Ncic Information Form is a legal document that was released by the Kansas Judicial Branch - a government authority operating within Kansas.

Form Details:

  • Released on July 1, 2017;
  • The latest edition currently provided by the Kansas Judicial Branch;
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  • Fill out the form in our online filing application.

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SERVICE COVER SHEET AND NCIC INFORMATION FORM
THIS FORM IS NOT TO BE INCLUDED IN THE PUBLIC RECORD AND SHOULD BE
DESTROYED ONCE THE REQUIRED INFORMATION IS ENTERED IN THE NCIC FILE.
This information is intended to be used by law enforcement to identify the defendant for
enforcement of the order and for entry into the National Crime Information Center (NCIC)
database. Please fill out the information as completely and correctly as possible, be particularly
careful with the dates of birth and spelling of names. PLEASE PRINT.
If there is more than one person being protected by the order (i.e. children), use the second page
to provide information about each protected person.
Restrained Person/Defendant’s Name:
Restrained Person/Defendant Identifiers: (Please include all
available information.)
SEX
RACE
DOB
HT
WT
Any other name(s) Defendant has been known by:
____________________________________________
HAIR
EYES
SOCIAL SECURITY NUMBER
____________________________________________
Defendant can be found at (give all available addresses):
DRIVERS LICENSE #
DL STATE
DL EXP. DATE
Home Address: ________________________________
___________________________________________
VEHICLE MAKE
VEHICLE MODEL
VEHICLE YEAR
___________________________________________
Phone number(s): ____________________________
Times Defendant is usually there_________________
__________________________________________
Distinguishing Features (tattoos, scars, locations frequented, etc.):
Place of employment: __________________________
Please describe: ___________________________________________
___________________________________________
________________________________________________________
___________________________________________
________________________________________________________
Phone number(s): ____________________________
________________________________________________________
Times Defendant is usually there_________________
________________________________________________________
__________________________________________
________________________________________________________
Other Address: ________________________________
Does Defendant wear glasses?
Yes
No
___________________________________________
___________________________________________
Does Defendant own or possess any weapons?
Yes
No
Phone number(s): ____________________________
If so, what kind(s)? ________________________________________
Times Defendant is usually there_________________
_______________________________________________________
___________________________________________
_______________________________________________________
_______________________________________________________
Protected Person’s Name:
Protected Person’s Identifiers:
Full Date of Birth (mm/dd/yyyy)
(It is important to include the protected person’s full date of birth)
Relationship to Defendant:
are or
have been in a dating relationship
Sex:
Female
Male
reside together or
formerly resided together
have a child in common
Race __________________
Rev. 7/2017 KSJC
SERVICE COVER SHEET AND NCIC INFORMATION FORM
THIS FORM IS NOT TO BE INCLUDED IN THE PUBLIC RECORD AND SHOULD BE
DESTROYED ONCE THE REQUIRED INFORMATION IS ENTERED IN THE NCIC FILE.
This information is intended to be used by law enforcement to identify the defendant for
enforcement of the order and for entry into the National Crime Information Center (NCIC)
database. Please fill out the information as completely and correctly as possible, be particularly
careful with the dates of birth and spelling of names. PLEASE PRINT.
If there is more than one person being protected by the order (i.e. children), use the second page
to provide information about each protected person.
Restrained Person/Defendant’s Name:
Restrained Person/Defendant Identifiers: (Please include all
available information.)
SEX
RACE
DOB
HT
WT
Any other name(s) Defendant has been known by:
____________________________________________
HAIR
EYES
SOCIAL SECURITY NUMBER
____________________________________________
Defendant can be found at (give all available addresses):
DRIVERS LICENSE #
DL STATE
DL EXP. DATE
Home Address: ________________________________
___________________________________________
VEHICLE MAKE
VEHICLE MODEL
VEHICLE YEAR
___________________________________________
Phone number(s): ____________________________
Times Defendant is usually there_________________
__________________________________________
Distinguishing Features (tattoos, scars, locations frequented, etc.):
Place of employment: __________________________
Please describe: ___________________________________________
___________________________________________
________________________________________________________
___________________________________________
________________________________________________________
Phone number(s): ____________________________
________________________________________________________
Times Defendant is usually there_________________
________________________________________________________
__________________________________________
________________________________________________________
Other Address: ________________________________
Does Defendant wear glasses?
Yes
No
___________________________________________
___________________________________________
Does Defendant own or possess any weapons?
Yes
No
Phone number(s): ____________________________
If so, what kind(s)? ________________________________________
Times Defendant is usually there_________________
_______________________________________________________
___________________________________________
_______________________________________________________
_______________________________________________________
Protected Person’s Name:
Protected Person’s Identifiers:
Full Date of Birth (mm/dd/yyyy)
(It is important to include the protected person’s full date of birth)
Relationship to Defendant:
are or
have been in a dating relationship
Sex:
Female
Male
reside together or
formerly resided together
have a child in common
Race __________________
Rev. 7/2017 KSJC
SERVICE COVER SHEET AND NCIC INFORMATION FORM
Other Protected Persons Information
Protected Person’s Name:
Protected Person’s Identifiers:
Full Date of Birth (mm/dd/yyyy)
(It is important to include the protected person’s full date of birth)
Relationship to Defendant:
are or
have been in a dating relationship
Sex:
Female
Male
reside together or
formerly resided together
have a child in common
Race __________________
Protected Person’s Name:
Protected Person’s Identifiers:
Full Date of Birth (mm/dd/yyyy)
(It is important to include the protected person’s full date of birth)
Relationship to Defendant:
are or
have been in a dating relationship
Sex:
Female
Male
reside together or
formerly resided together
have a child in common
Race __________________
Protected Person’s Name:
Protected Person’s Identifiers:
Full Date of Birth (mm/dd/yyyy)
(It is important to include the protected person’s full date of birth)
Relationship to Defendant:
are or
have been in a dating relationship
Sex:
Female
Male
reside together or
formerly resided together
have a child in common
Race __________________
Protected Person’s Name:
Protected Person’s Identifiers:
Full Date of Birth (mm/dd/yyyy)
(It is important to include the protected person’s full date of birth)
Relationship to Defendant:
are or
have been in a dating relationship
Sex:
Female
Male
reside together or
formerly resided together
have a child in common
Race __________________
Protected Person’s Name:
Protected Person’s Identifiers:
Full Date of Birth (mm/dd/yyyy)
(It is important to include the protected person’s full date of birth)
Relationship to Defendant:
are or
have been in a dating relationship
Sex:
Female
Male
reside together or
formerly resided together
have a child in common
Race __________________
Rev. 7/2017 KSJC
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