Missouri Department of Social Services Children’s Division Request for Location Services

SECTION A—REQUESTOR’S INFORMATION
1. Name of Requestor	2. Requestor’s County	3. Requestor’s User ID
4. Requestor’s Address	5. Requestor’s Telephone # (include area code)
6. City	7. State	8. Zip Code
9. Child’s Name	10. Child’s DCN	11. Case Number
PURPOSE OF REQUEST
12. Locate Parent Locate Relative
SECTION B--INFORMATION ON INDIVIDUAL TO BE LOCATED
13. Name (Last, First, Middle)(Aliases)
14. License Information
SSN	License # (CLN)
15. Relationship to the Child
Biological Mother Biological Father Step Parent Adoptive Parent Legal Guardian Relative
16. Phone Number (include area code)	17. Date of Birth	18. Birthplace (City & State)
19. Sex	20. Height	21. Weight	22. Eye Color
23. Last Known Address (Number and Street)
24. City	25. State	26. Zip Code	27. Date Address Last Known
28. Parent 1 Name (Last, First, Middle, Maiden)(Aliases)	29. Parent 2 Name (Last, First, Middle)(Aliases)
30. Requestor’s Signature Date	31. Supervisor’s Signature Date
SECTION C—(TO BE COMPLETED BY AUTHORIZED PERSONNEL) If there are blank fields in Section 2 which become known in this search; please enter the information in the appropriate field.
32. DMV Systems checked:
DMDI (Driver ID) NAMS (Name Cross Ref) LICA (License Registration) DMBN (Marine)
33. Resident Address & As of Date:	34. Most Current Address & As of Date:
35. State License Surrendered To/From:	36. Aliases:
To:	From:
37. Lienholder Information:
38. NO INFORMATION WAS AVAILABLE	39. DECEASED
40. Authorized Staff Signature	41. Staff User ID	42. Date