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Phone 773-685-5699 Fax 773-685-5433 www. accuratebiometrics. com Out of State Fingerprinting Form Last Name First Name MI Address City State Zip Code Date of Birth // Sex Race Height Weight Hair Color Eye Color Social Security -- Place of Birth State or Country if outside USA Please check purpose of fingerprinting below Registered Nurse RN Licensed Practical Nurse LPN Security PERC Massage Therapy Other Chiropractic Licensee Physician Licensee Be sure to include the following in mailing...
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