Page of 8 If FemaleMaiden DOB Race Social Security # Birth City StateCountry Birth Hospital MM DD YYYY Address Apt # City State Zip County Country Inside City Limits Religious Preference Education: level completed. ElemSecond (0-): College Degree Earned: Alias Alias Phone (H) Phone (W) Phone (Cell) Marital Status Legal Next of Kin Address Relationship: Wife Husband Father Mother Brother Sister Son Daughter Employer Friend Home City State Zip On SiteCell Phone Permanent Contact Married Never Married Widowed Divorced Separated Unknown Please place name and contact info here. Work ( MM DD YYYY ) Mother Living Deceased Unknown MaidenBirth name Wedding Date Spouse Living Deceased Unknown MaidenBirth name Father Living Deceased Unknown Please place other here Contact Address City State Zip Home Phone Work Phone Cell Phone email Date of Contact Type of Contact Relationship Wife Husband Father Mother Brother Sister Son Daughter Employer Friend Contact Address City State Zip Home Phone Work Phone Cell Phone email Date of Contact Type of Contact Relationship Wife Husband Father Mother Brother Sister Son Daughter Employer Friend Contact Address City State Zip Home Phone Work Phone Cell Phone email Date of Contact Type of Contact Relationship Wife Husband Father Mother Brother Sister Son Daughter Employer Friend
Page of 8 Height: Approx. Weight (Pounds): Hair Color Auburn Blonde Brown Black Gray Red Salt & Pepper White Please place other here Hair Information Hair Length Hair Accessory Extensions Hair Piece Hair Transplant Wig Hair Curly Wavy Straight NA : Facial Hair Type Facial Hair Color Bald Shaved Short < " Medium Male Patern Baldness: Long Clean Shaven Moustache Blonde Brown Black Gray Beard & Moustache Beard Red Salt & Pepper Goatee Stubble White Sideburns Lower Lip Facial Hair tes NA Eye Info Eye Color Optical Lens Blue Brown Green Hazel Gray Black Contacts Glasses Implants ne ColorDescrip: Desc. Eye Status Missing R Missing L Glass R Glass L Cataract NA NAIL Info Fingernail Type Fingernail Color Characteristics Toenail Color Characteristics Natural Artificial Unknown Length Extremely Long Long Medium Short Bitten Decorated Misshapen YellowedFungus NA Toenail description Bitten Decorated Misshapen YellowedFungus NA Body Piercing(s)? Photos? Photo Location # Location Side Quantity (include evidence of old piercings) Photo Tattoo(s) Photos? Photo Location # Location Side
Page of 8 Dental Info Dentist Address City State Zip Additional Dental Informationnd Dentist: Unknown Phone Never Went Dental Work Dentures Both Braces Partials Tooth Jewelry Physician Info Physician Address Address City State Zip Phone Phone Email Practice Physician Type Seen for Records Requested Records Obtained Medical Radiographs? Physician(s) Unknown Address Medical Radiographs Location Potential Type of Radiographs - and dates taken if known Old Fractures: : Objects in Body: Surgery Gall Bladder Appendectomy Pacemaker Bullets Implants Needles Shrapnel Tracheotomy Laparotomy Caesarean Mastectomy Reconstructive Open heart Please place other objects here Please place other surgery here Diabetic? Unknown If Female pregnancy in the past months? Unknown Unique Characteristics of: Scars, Operations, birthmarks, burns, missing organs, amputations, other special characteristics Prosthetic(s) Prosthetic Location Additional Information
Page 4 of 8 Group Status: Alone Group Group FamGrp : Type: Family, Church Group, Sports,Military seen with If Family Group, list names here location victim was seen Military Service Unknown Military DNA Taken: Unknown Country Approximate Service Date Service #: Military Branch Ever Finger Printed: Immigration Status Resident Alien Card (Green Card) Fingerprints Footprints Ever been Arrested Print located Arrested By: Usual Occupation: Employer Type of Business Phone Employer Address Please list last employer if retired. Additional employers enter in additional data section List memberships: Clubs, Fraternities, etc. Additional Data
Page 5 of 8 WATCH: # Type Make Band Material Color Inscription Photo Available Gold color is denoted by yellow, silver color is denoted by white # Jewelry Typestyle Material Color Stone Color Size Where Worn Frequently Worn? Inscription Photo Available JEWELRY: 4 5 6 7 8 9 Commonly Carried Personal Effects Cell phone Unknown Cell phone type: Service provider: Cell phone number Cell phone description
Page 6 of 8 # Clothing Items Color Size 4 5 6 7 8 CLOTHING: 9 0 4 5 6 7 8 9 0 Wallet: Purse: Contents Contents Pockets: Contents Left Contents Right
Page 7 of 8 Potential Living Biological Donors All Biololgical Relatives of Missing Individual----MotherFatherSpouseSisterBrotherChildrenUncleAuntCousin Email DOB Email DOB Email DOB 4 Email DOB 5 Email DOB 6 Email DOB 7 Email DOB 8 Email DOB Primary donor for Nuclear DNA Analysis An appropriate family member for nuclear DNA Analysis is someone that is biologically related to and only one generation removed from the deceased. The following are the family members who are appropriate donors to provide reference specimens, and in the order of preference (family members highlighted in bold print are the most desirable):. Natural (Biological) Mother and Father, AND. Spouse and Natural (Biological) Children, AND. A Natural (Biological) Mother or Father and victim s biological children, OR 4. Multiple Full Siblings of the Victim (i.e., children from the same Mother and Father
Page 8 of 8 Interview_Location Interview_Date (MMDDYYYY) Interview_Time Interviewer Info: Interviewer Interviewing_Organization Interviewer Home Information Interviewer Address: Interviewer home phone: Street, City State, Zip Interviewer cell phone: Interviewer work phone: Interviewer On-Site Information Interviewer on-site address Street, Hotel, Room # Interviewer on-site phone: Interviewer on-site cell: Reviewer Info: Reviewer Reviewer Signature Reviewing agency