CLEAN ENTRY WORKSHEETS
The associated worksheets are provided as entry worksheets for entries into CLEAN /NCIC. These templates are available in Microsoft Word as template files. The agency requesting an entry into CLEAN / NCIC should fill in the information on the worksheet and email, fax or mail the worksheet to the entering terminal agency.
It is a requirement that all terminal agencies that enter records into CLEAN / NCIC have supportive documentation on file for the entry. Once the entry is made into CLEAN / NCIC a copy of the entry should be returned to the requesting agency and filed in their appropriate group file. Additionally the original entry message and worksheet (supportive documentation) should be filed at the entering agency.
STOLEN GUN
CLEAN / NCIC ENTRY WORKSHEET
AGENCY NAME:
OFFICER NAME:
AGENCY (ORI):
DATE OF REPORT:
GUN INFORMATION:
MAKE (MAK):
MODEL (MOD):
CALIBER (CAL):
TYPE (TYP):
SERIAL NUMBER (SER):
INVESTIGATIVE REPORT NUMBER (OCA):
DATE OF THEFT (DOT):
MISCELLANEOUS (MIS):
COMPLETED BY ENTERING AGENCY
ENTERED BY:
CHECKED BY:
DATE / TIME ENTERED:
COPY OF ENTRY PROVIDED TO REQUESTING AGENCY: YES NO
VEHICLES\REGISTRATION
TYPE OF ENTRY: STOLEN VEHICLE STOLEN LICENSE PLATE FELONY VEHICLE
CLEAN/NCIC ENTRY WORKSHEET
AGENCY NAME:
OFFICER NAME:
AGENCY (ORI):
DATE OF REPORT:
REGISTRATION INFORMATION:
NUMBER (LIC):
STATE (LIS):
YEAR (LIY):
TYPE (LIT):
VEHICLE INFORMATION:
VEHICLE IDENTIFICATION NUMBER (VIN):
YEAR (VYR):
MAKE (VMA):
MODEL (VMO):
STYLE (VST):
COLOR (VCO):
DATE OF THEFT (DOT):
INVESTIGATIVE REPORT NUMBER (OCA):
OWNER APPLIED NUMBER (OAN):
MISCELLANEOUS (MIS):
INFORMATION VERIFIED FROM COMPLAINANT/INVESTIGATIVE REPORT:
YES NO
COMPLETED BY ENTERING AGENCY
VEHICLE INFORMATION VERIFIED THROUGH BUREAU OF MOTOR VEHICLES:
YES (ATTACHED) NO
ENTERED BY:
CHECKED BY:
DATE/TIME OF ENTRY:
COPY OF ENTRY PROVIDED TO REQUESTING AGENCY: YES NO
WANTED PERSON
CLEAN/NCIC ENTRY WORKSHEET
TYPE OF ENTRY: CAUTION PA ONLY (EWN) NO EXTRADITION
NCIC (EW)– ENTER EXTRADITION LIMITATIONS IN MIS FIELD
AGENCY NAME:
OFFICER NAME:
AGENCY (ORI):
DATE OF REPORT:
INVESTIGATIVE REPORT NUMBER (OCA):
DATE OF WARRANT (DOW):
OFFENSE (OFF):
WANTED PERSON SUBJECT INFORMATION:
NAME (NAM):
SEX (SEX):
RACE (RAC):
HEIGHT (HGT):
WEIGHT (WGT):
HAIR COLOR (HAR):
EYE COLOR (EYE):
PLACE OF BIRTH (POB):
SCARS, MARKS, TATOOS (SMT):
FINGERPRINT CLASSIFICATION (FPC):
DATE OF BIRTH (DOB):
SOCIAL SECURITY NUMBER (SSN):
NUMBER (OLN):
STATE (OLS):
YEAR (OLY):
DRIVER OPERATOR LICENSE INFORMATION:
MISCELLANEOUS NUMBER (MNU):
MISCELLANEOUS INFORMATION – ENTER EXTRADITION IF NOT NATIONWIDE (MIS):
FBI NUMBER (FBI):
ASSOCIATED VEHICLE REGISTRATION INFORMATION:
NUMBER (LIC):
STATE (LIS):
YEAR (LIY):
TYPE (LIT):
ASSOCIATED VEHICLE IDENTIFICATION INFORMATION:
VEHICLE IDENTIFICATION NUMBER (VIN):
MAKE (VMA):
YEAR (VYR):
MODEL (VMO):
STYLE (VST):
COLOR (VCO):
INVESTIGATING AGENCY:
A SIGNED AND SEALED WARRANT MUST BE AVAILABLE PRIOR TO ENTRY
INVESTIGATIVE REPORT CHECKED TO VERIFY INFORMATION CORRECTNESS
EXTRADITION VERIFIED THROUGH PROPER AUTHORITY
COMPLETED BY ENTERING AGENCY
CLEAN / NCIC RECORDS CHECKED TO OBTAIN ADDITIONAL INFORMATION, ADDITIONAL INFORMATION PROVIDED TO INVESTIGATING AGENCY YES NO
ENTERED BY:
CHECKED BY:
DATE / TIME ENTERED:
COPY OF ENTRY PROVIDED TO REQUESTING AGENCY: YES NO
MISSING PERSON
CLEAN/NCIC ENTRY WORKSHEET
TYPE OF ENTRY: JUVENILE (EMJ) INVOLUNTARY (EMI) ENDANGERED (EME)
DISABILITY (EMD) CATASTROPHE (EMV) OTHER (EMO)
AGENCY NAME:
OFFICER NAME:
AGENCY (ORI):
DATE OF REPORT:
INVESTIGATIVE REPORT NUMBER (OCA):
DATE OF LAST CONTACT (DLC):
TIME OF LAST CONTACT (TLC):
MISSING PERSON SUBJECT INFORMATION:
NAME (NAM):
SEX (SEX):
RACE (RAC):
HEIGHT (HGT):
WEIGHT (WGT):
HAIR COLOR (HAR):
EYE COLOR (EYE):
PLACE OF BIRTH (POB):
SCARS, MARKS, TATOOS (SMT):
FINGERPRINT CLASSIFICATION (FPC):
DATE OF BIRTH (DOB):
SOCIAL SECURITY NUMBER (SSN):
JEWLERY TYPE (JWT):
JEWLERY LOCATION (JWL):
NUMBER (OLN):
STATE (OLS):
YEAR (OLY):
DRIVER OPERATOR LICENSE INFORMATION:
MISCELLANEOUS NUMBER (MNU):
MISCELLANEOUS INFORMATION (MIS):
FBI NUMBER (FBI):
ASSOCIATED VEHICLE REGISTRATION INFORMATION:
NUMBER (LIC):
STATE (LIS):
YEAR (LIY):
TYPE (LIT):
ASSOCIATED VEHICLE IDENTIFICATION INFORMATION:
VEHICLE IDENTIFICATION NUMBER (VIN):
MAKE (VMA):
YEAR (VYR):
MODEL (VMO):
STYLE (VST):
COLOR (VCO):
BLOOD TYPE (BLT):
CIRCUMCISION (CRC):
FOOTPRINTS AVAILABLE (FPA):
BODY X-RAY (BXR):
CORRECTIVE VISION PERSCRIPTION (VRX):
INVESTIGATING AGENCY: JUVENILE – SENT LETTERS TO SCHOOL AND VITAL STATISTICS
ADULT – COMPLAINANT SIGNED A MISSING PERSON DECLARATION
ALL ENTRIES MUST BE UPDATED WITHIN 60 DAYS AS PER FEDERAL ACT
COMPLETED BY ENTERING AGENCY
CLEAN / NCIC RECORDS CHECKED TO OBTAIN ADDITIONAL INFORMATION, ADDITIONAL INFORMATION PROVIDED TO INVESTIGATING AGENCY YES NO
ENTERED BY:
CHECKED BY:
DATE / TIME ENTERED:
COPY OF ENTRY PROVIDED TO REQUESTING AGENCY: YES NO