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PENNSYLVANIA STATE POLICE SP 4164 (72009) REQUEST FOR CRIMINAL RECORD CHECK This form is to be Completed In ink by the requester (information will be mailed to the requester only). If this form is
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Ink by form requester is a document that must be completed in writing by a requester.
Anyone who needs to make a formal request in writing.
You must carefully fill out all the required fields with ink.
The purpose is to have a written record of the request.
The requester's name, date, request details.
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