National Crime Information Center (NCIC) - City of Minneapolis
National Crime Information Center (NCIC) - City of Minneapolis
National Crime Information Center (NCIC) - City of Minneapolis
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DENTAL HISTORY INFORMATION<br />
______________________________________________________________________________<br />
Missing Person's Name Date <strong>of</strong> Birth<br />
______________________________________________________________________________<br />
Investigating Agency's Name Agency Case Number<br />
________________________________________<br />
Investigating Officer's Name<br />
*******************************************************************************<br />
The information requested on these forms will be used to assist in the identification process. Your<br />
cooperation in completing these forms is appreciated.<br />
AUTHORIZATION TO RELEASE DENTAL RECORD<br />
I am the parent/legal guardian/next <strong>of</strong> kin <strong>of</strong> the above-named missing person and I hereby authorize the<br />
release <strong>of</strong> medical records to assist criminal justice agencies in locating the missing person.<br />
______________________________________<br />
Signature <strong>of</strong> Parent/Legal Guardian/Next <strong>of</strong> Kin<br />
_______________________________________<br />
Date<br />
_______________________________________<br />
Relationship<br />
_______________________________________<br />
Street Address<br />
_______________________________________<br />
<strong>City</strong>, State, and ZIP<br />
_______________________________________<br />
Telephone Number
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