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INFORMATION SHEET

 

Client Information: Please provide the following information in case you have to be contacted during the course of the investigation.

Name: ___________________________________________________________________________

Harvey Charyn

618 Bellmore Ave

East Meadow NY 11554

(516) 538-7490

FAX538-7490

 
 


Home address:____________________________________________________________________

 

Work address:_____________________________________________________________________

 

Home phone:________________________Work phone:___________________________________

 

Other phones/ pages/ E-Mail:_________________________________________________________

 

 

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Subject information:

Full name:________________________††††††††††† Date of birth:_________________________________

 

S.S. number:_________________________________________________________________________

 

Height:__________Weight:____________Hair color:________________Eye Color:_______________

 

Any AKAís:__________________Maiden name:____________________________________________

 

Current address and last known address:_________________________________________________

 

Post Office Box:_____________________________________________________________________

 

Drivers License ________________________________State issued:__________________________

 

Vehicles:________________________________________

 

Employment name address and phone number:______________________________________________________________________________

 

Work schedule, occupation and title:______________________________________________________

 

Please list any locations (bars, gyms, friends residence ) that the subject might frequent.

index.htm††††††††††††††††††††

 

 

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