DATE OF BIRTH
MM
DD
YY
SOCIAL SECURITY NO.
STATE IDENTIFICATION
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CITIZENSHIP
ADDRESS
SIGNATURE OF FINGERPRINTED PERSON
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3. R. MIDDLE
4. R RING
5. R LITTLE
1. L THUMB
2. L INDEX
3. L MIDDLE
4. L RING
5. L LITTLE
FOUR FINGERS TAKEN SIMULTANEOUSLY
LEFT HAND
AMPUTATION
L. THUMB
R. THUMB
FOUR FINGERS TAKEN SIMULTANEOUSLY
RIGHT HAND
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4. L RING
5. L LITTLE
FOUR FINGERS TAKEN SIMULTANEOUSLY
RIGHT HAND