LIVE-SCAN CRIMINAL HISTORY REQUEST	PROCESSING CATEGORY: RFA / INDEPENDENT ADOPTION VISITATION MONITOR PARENT REUNIFICATION PROBATE GUARDIANSHIP
DATE:

I. CHILD’S PLACEMENT STATUS:

Case Name	Child’s Name	Child’s name	Case/State ID# Referral #, RFA #

II. RELATIVE/PERSON TO BE FINGERPRINTED:

Name:	Relationship to Child:
ID Type:
DOB:	Sex:	Contact number:	Expiration Date:
Name:	Relationship to Child:
ID Type:
DOB:	Sex:	Contact number:	Expiration Date:
Name:	Relationship to Child:
ID Type:
DOB:	Sex:	Contact number:	Expiration Date:
Name:	Relationship to Child:
ID Type:
DOB:	Sex:	Contact number:	Expiration Date:

III. LIVE-SCAN RESULTS ARE TO BE RETURNED TO:

CWS/CMS Caseload File #	CSW Name (Print)	CSW Telephone
Office Name	SCSW Name (Print)

IV. LIVE-SCAN OFFICE LOCATIONS:

MAIL CODE	LOCATION CODE	OFFICE NAME	LOCATION	RECEPTION TELEPHONE #
04823	S3253	Belvedere	5835 S. Eastern Ave. Los Angeles CA 90040	(323) 725-4401
02602	S1277	Carson	1 Civic Plaza Drive Suite 100, Carson CA 90745	(310) 233-1000
04825	S1286	Children’s Court	201 Centre Plaza Dr., Monterey Park CA 91754	(323) 526-6767
04833	S1280	El Monte	2525 Corporate Pl., Monterey Park, CA 91754	(626) 455-4660
04826	S5252	Brand	611 N. Brand Blvd., Glendale CA 91203	(747) 307-2300
04826	S1254	Glendora	725 S. Grand Ave., Glendora CA 91740	(626) 691-1700
04832	S8234	Lancaster	300 E Avenue K6, Lancaster CA 93535	(661) 471-1001
05009	S3239	Metro North	1933 S. Broadway, Los Angeles CA 90007	(213) 763-1000
04831	S8326	Palmdale	39115 Trade Center Drive, Palmdale CA 93551	(661) 581-6000
04837	S1255	Pomona	801 Corporate Center Dr., Pomona CA 91768	(909) 802-1300
04838	S8251	Santa Clarita	28490 Avenue Stanford Ste 100, Santa Clarita CA 91355	(661) 702-6262
04839	S4261	Santa Fe Springs	10355 Slusher Dr., Santa Fe Springs CA 90670	(562) 903-5000
04834	S5211	W San Fern Valley	20151 Nordhoff St., Chatsworth CA 91311	(818) 717-4000
04830	S7207	South County	4060 Watson Plaza Dr., Lakewood CA 90712	(562) 497-3500
04821	S2213	Torrance	2325 Crenshaw Blvd., Torrance CA 90501	(310) 972-3111
04828	S6219	Vermont Corridor	8300 S. Vermont Ave., Los Angeles CA 90044	(323) 965-7060
04829	S2217	Wateridge	5110 W. Goldleaf Cir. Los Angeles CA 90056	(323) 290-8500
04820	S6260	West LA	5757 Wilshire Blvd, Los Angeles CA 90036	(323) 900-2222