BNI-6 (Rev. 3/96) PERSONAL HISTORY/ARREST REPORT

BNI-6 (Rev. 3/96) PERSONAL HISTORY/ARREST REPORT 1. USE (check applicable box): 2. Case Number 5. Fingerprinted ( ) Yes ( ) No

( ) Personal History ( ) Informant ID 3. OTN Number(s) 6. Probation ( ) Parole ( ) Where?

( ) Arrest Record ( ) Fugitive Declaration 4. Informant ID Number 7. NCIC Check ( ) Yes ( ) No Date:

8. Name (LAST, FIRST, MIDDLE) 9. Alias(es) or Other Name(s)

10. Permanent Address (include ZIP CODE) 10a. Telephone Number ( )

11. Other Address (if any) 11a. Telephone Number ( )

12. Date of Birth 13. Place of Birth (City/State) 14. Citizenship 15. Illegal Alien ( ) Yes ( ) No

16. Nationality 17. Race 18. Sex 19. Height 20. Weight 21. Eyes 22. Glasses 23. Hair ( ) M ( ) F (inches)

24. Build 25. Complexion 26. Identifying Characteristics (Scars, Marks, Tattoos, Etc.) 27. Drug User ( ) Yes ( ) No (If yes, list drug)

28. SSN # 29. FBI # 30. DEA # 31. SID # 32. Other Numbers (Federal, State, Local, etc.)

33. Employer/Address 34. Education 35. Vehicle Registration Information (Level/Name of School) Make/Model Year State

36. Driver's License Information: State or Country: License # Operator's License Number: Expiration Date: Expires:

7. Spouse: Address:

38. Immediate Family (Relationship): Address:

39. Address:

40. Address:

41. REMARKS: PA Megan’s Law Offender – ( ) Yes ( ) No”

42. Primary Officer: 43. Agency (BNI/PSP/TF/OTH):

44. Secondary Officer: 45. Agency (BNI/PSP/TF/OTH):

46. Reporting Date: 47. Date/Time of Arrest: 48. Where Arrested: 49. Occupation Code: (Municipal Code)

50. Class (1-4): 51. Type Violation: 52. Counts: 53. Drug Code:

54. Firearms: 55. Arrest by Result of: 56. Armed: ( ) Yes 57. Photographed: ( ) Yes (I)nvolved / (C)harged ( ) No ( ) No

58. Statement: ( ) Yes ( ) No 59. Funds at Arrest: 60. Other Controlled Substances/Drugs Involved: $

Officer's Signature/Date: Supervisor's Signature/Date: CODES FOR PERSONAL HISTORY/ARREST REPORT (BNI-6)

DRUG CODES OCCUPATIONAL CODES

CAN MAR Marihuana HWF Housewife

CAN CAN Other Cannabis LAB Laborer

DEP BAR Barbiturates MGR Manager

DEP DEP Other Depressants OFF Office Worker

HAL HAL Hallucinogens OPR Operative

HAL LSD LSD OTH Other

HAL PCP Phencyclidine PRO Professional

NAR CHW China White REG Registrant

NAR FEN Fentanyl SAL Sales

NAR HER Heroin SER Service Worker

NAR HYD Hydromorphone SKC Skilled Laborer

NAR ONA Other Narcotic STU Student

STI AMP Amphetamines TEC Technician

STI COC Cocaine UNE Unemployed

STI CRK Crack UNK Unknown

STI MTH Methamphetamines TYPE OF VIOLATION

STI STM Other Stimulants A12 Forgery (13-A-12)

STR ANA Anabolic A13 Maintaining a Drug Dependent Person (13-A- 13)

STR STR Other Steroids A14 Illegal Prescription or Dispensing for Non- Medical Reason (13-A-14)

DRL OTH Other Than Drug 699 Pharmacy Act

DRL PAR Paraphernalia CON Conspiracy (PCC 903)

DRL PRE Precursors DEL Delivery (13-A-30)

DRL THF Theft MFG Manufacturing (13-A-30)

MIS DD Designer Drugs OTH Other

MIS ODR Look-Alike Drugs POS Possession (13-A-16)

MIS NPD Non-Proprietary Drug PWI Possession with Intent to Deliver (13-A-30)

MIS PPD Proprietary Drug