Colorado Name Change FBI Background Check Form

If you want to initiate a legal name change process in the State of Colorado, you need an FBI background check. In order to get this background check, you need to use this form.

Extracted Text for Proper Search

FD-258 (REV.12-10-07)	
LEAVE BLANK	

APPLICANT	

TYPE OR PRINT ALL INFORMATION IN BLACK	FBI	LEAVE BLANK	LAST NAME	FIRST NAME	MIDDLE NAME	NAM	
ALIASES	AKA	
DATE OF BIRTH	DOB	Month      Day        Year
PLACE OF BIRTH	POB	SEX	RACE	HGT.	WGT.	EYES	HAIR	
LEAVE BLANK	
CITIZENSHIP	CTZ	
YOUR NO.	OCA	
O
RI	
CLASS
REF.	
FBI NO.	FBI	
ARMED FORCES NO.	MNU	
SOCIAL SECURITY NO.	SOC	
MISCELLANEOUS NO.	MNU	
SIGNATURE OF PERSON FINGERPRINTED
RESIDENCE OF PERSON FINGERPRINTED
DATE
EMPLOYER AND ADDRESS
REASON FINGERPRINTED	
SIGNATURE OF OFFICIAL TAKING FINGERPRINTS	
 1. R. THUMB	2.  R. INDEX	3.  R. MIDDLE	4.  R. RING	5. R. LITTLE	
6. L. THUMB	7.  L. INDEX	8.  L. MIDDLE	9.  L. RING	10. L. LITTLE	
L. THUMB	R. THUMB	RIGHT FOUR FINGERS TAKEN SIMULTANEOUSLY	LEFT FOUR FINGERS TAKEN SIMULTANEOUSLY	
* See Privacy Act Notice on Back

FEDERAL BUREAU OF INVESTIGATION	
UNITED STATES DEPARTMENT OF JUSTICE	
CJIS DIVISION/CLARKSBURG, WV  26306	
APPLICANT	
THIS CARD FOR USE BY:
1.    LAW ENFORCEMENT AGENCIES IN FINGERPRINTING APPLICANTS FOR LAW ENFORCEMENT POSITIONS.* 
2.    OFFICIALS OF STATE AND LOCAL GOVERNMENTS FOR PURPOSES OF EMPLOYMENT, LICENSING, AND
PERMITS, AS AUTHORIZED BY STATE STATUTES AND APPROVED BY THE ATTORNEY GENERAL OF THE
UNITED STSTES.  LOCAL AND COUNTY ORDINANCES, UNLESS SPECIFICALLY BASED ON
APPLICABLE STATE STATUTES DO NOT SATISFY THIS REQUIREMENT.*
3.    U.S. GOVERNMENT AGENCIES AND OTHER ENTITIES REQUIRED BY FEDERAL LAW.**
4.    OFFICIALS OF FEDERALLY CHARTERED OR INSURED BANKING INSTITUTIONS TO PROMOTE OR MAINTAIN
THE SECURITY OF THOSE INSTITUTIONS.
1.    PRINTS MUST GENERALLY BE CHECKED THROUGH THE APPROPRIATE STATE IDENTIFICATION BUREAU, AND ONLY THOSE 
FINGERPRINTS FOR WHICH NO DISQUALIFYING RECORD HAS BEEN FOUND LOCALLY SHOULD BE SUBMITTED FOR FBI SEARCH.
2.    IDENTITY OF PRIVATE CONTRACTORS SHOULD BE SHOWN IN SPACE “EMPLOYER AND ADDRESS”.  THE
CONTRIBUTOR IS THE NAME OF THE AGENCY SUBMITTING THE FINGERPRINT CARD TO THE FBI.
3.    FBI NUMBER, IF KNOWN, SHOULD ALWAYS BE FURNISHED IN THE APPROPRIATE SPACE.
MISCELLANEOUS NO. - RECORD:  OTHER ARMED FORCES NO. PASSPORT NO. [FP], ALIEN REGISTRATION NO.
(AR), PORT SECURITY CARD NO. (PS), SELECTIVE SERVICE NO. (SS) VETERANS’ ADMINISTRATION CLAIM NO. (VA).
**
*
INSTRUCTIONS:	
FD-258 (REV. 12-10-07)
ARCHES HAVE NO DELTAS	
3. A RCH	
THESE LINES RUNNING BETWEEN
DELTAS MUST BE CLEAR	
CENTER
OF LOOP	
2. WHORL	
DELTAS	
THE LINES BETWEEN CENTER OF LOOP AND DELTA MUST SHOW	
DELTA	
1. LOOP	
1110-0046 3/21/2010	
Please review this helpful information to aid in the successful processing of hard copy criminal and civil fingerprint submissions in order to prevent delays 
or rejections.  Hard copy fingerprint submissions must meet specific criteria for processing by the Federal Bureau of Investigation. Ensure all information is typed or legibly printed using blue or black ink.
Enter data within the boundaries of the designated field or block.
Complete all required fields.  (If a required field is left blank, the fingerprint card may be immediately rejected without further processing.)        •The required fields for hard copy fingerprint cards are:  originating agency identifier number - date of birth - place
of birth - name - sex fingerprint impressions - any applicable state stamp - Other (race, height, weight, eye color,
hair color) * criminal fingerprint cards also require an arrest charge and date of arrest.
* civil fingerprint cards also require a reason fingerprinted and date fingerprinted
Do not use highlighters on fingerprint cards.  
Do not enter data or labels within ‘Leave Blank’ areas.
Ensure the ‘Reply Desired’ field is checked when applicable (criminal only).
Ensure fingerprint impressions are rolled completely from nail to nail.
Ensure fingerprint impressions are in the correct sequence.
Ensure notations are made for any missing fingerprint impression (i.e. amputation).
Do not use more than two retabs per fingerprint impression block.
Ensure no stray marks are within the fingerprint impression blocks.
Training aids can be ordered online via the Internet by accessing the FBI’s website at:  fbi.gov, click on ‘Fingerprints’, then click on ‘Ordering
Fingerprint Cards & Training Aids’.  Direct questions to the Identification and Investigative Services Section’s Customer Service Group at (304) 625-5590
or by e-mail at .
PRIVACY ACT STATEMENT
Authority:  The FBI's acquisition, preservation, and exchange of information requested by this form is generally authorized under 28 U.S.C. 534.  Depending on the nature of your application, supplemental authorities include numerous Federal statutes, hundreds of State statutes