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DMV Photo Subject Information Name: ClientiD: Case Number: SI DMV Transaction Number: 1069006 DMV Transaction Date/Time: 2019-06-05 18:36:18:690 EFTA00005775

Last updated: 01108/2017 Request for NYS DMV P OTO IMAGE To: New York Ops Center (NYOC) [office: 212-384-2921; fax: 212-384-4073 or 4074) Requestor Email: Sq t ad: e--; 1) Name & Rank of Requestor. MUST be Special Agent or other 3, 2) Name & Rank of Supervisor: MUST be Supervisory Special Agent or of 3) Subject Name: 4) DMV Client ID # (Nine Digits): If nn Client ID available, include Subject's D rB role one): ant Investigation Witness Investigation 6) Exigent Circums ances (if applicable)*: Comments Ir***sh*******—Ir --n.freevisac e support personnel Missing Person Investigation 7) Case number: 8) Phone number of Requestor: The requestor acknowledges that the mquested image cannot be used as filjgg in a phot in an any if the subject of the DMV photo is the subject in the photo array. A new request unrelated criminal investigation. The digital image obtained will not be saved in a database subsequent use unrelated to the original investigation. I hereby certify that the above-requested DMV Photo Image b relevant to as a my knowledge, the subject of interest possesses a driver's II e, learner's permit or non New York State DA J and acknowledge hat I r oat was for an hope ature) Date *When the exigent circumstances exception applies, the "Comments" section must identify the t urgency. In addition, the "Request for DNS/ Photo Imago — Exigent Cncwmtances" form must requesting agency. 1' it. Investigation and that, to the best of ;river identtlleatIon card issued the 1 ... Me jurrpose I may be subject to y, the OW photo may only be used r a photo image must be made for any stored in any manner for secondary or /, f investigation and explain the pitted and retained by the EFTA00005776

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