Free Protective Order TCIC Data Entry Form.PDF - Texas

PROTECTIVE ORDERS
Data Entry Form for TEXAS CRIME INFORMATION CENTER (TCIC)

The intent of this form is to aid court clerks with the collecting and providing to local law enforcement agencies pertinent information regarding protective orders for the purpose of entry into TCIC.
To be filled out by Criminal Justice/Law Enforcement Official: ORI: _______________
(check one) PROTECTIVE

ORDER: ________ EMERGENCY PROTECTIVE ORDER: ________

OCA: __________ PROTECTIVE ORDER NO: ______________ COURT IDENTIFIER: ___________________________ ISSUE DATE: ____________ DATE OF EXPIRATION: _________________ DATE OF DISMISSAL: ________________

***RESPONDENT INFORMATION***
Items in ALL UPPERCASE LETTERS must be answered to allow entry into TCIC. NAME OF RESPONDENT: ____________________________________________________ RACE: (circle one) Indian Asian Black White Unknown Ethnicity: (circle one) Hispanic SEX:
(circle one)

M

F

Non-Hispanic

Unknown

Place of Birth: (State) __________________________ DATE OF BIRTH: ___________ HEIGHT: ________ WEIGHT: __ Skin: (circle one) Albino Black Dark Dk Brown Fair Light Lt Brown Medium Med Brown Olive Ruddy Sallow Yellow Unknown EYE COLOR: (circle one) HAIR COLOR: (circle one) Black Black Blue Blond Brown Brown Gray Gray Green Red Hazel White Maroon Sandy Pink Bald Multi-Colored Unknown Unknown

Scars, Marks and/or Tattoos (please describe in detail): __________________________________________________________ _________________________________________________________________________________________________________ RELATIONSHIP TO PROTECTED PERSON: ________________________________________________________________

(PLEASE INCLUDE THE FOLLOWING NUMERIC IDENTIFIERS, IF AVAILABLE): Texas I.D. No: _________________ Misc. I.D. No: _______________________ Social Security No: ______________________ Driver's License No: _________________ Driver's License State: _______________ Date of Expiration: _________________

Respondent's Adress: Street: ________________________ City: ___________ State: __________ Zip: _______ COUNTY: _______________

Respondent's Vehicle Information: License Plate No: _____________ L.P. State:__________ L.P. Year of Expiration: ________ L.P. Type: ____________ Vehicle I.D. #: __________________ Year: _____ Make: _______ Model: ________ Style: ________ Color: _________ To be filled out by Criminal Justice/Law Enforcement Official: SID #: __________________ FBI #: __________________ FPC: __________________________
MNU: _______________

TEXAS DEPARTMENT OF PUBLIC SAFETY (JANUARY 2096) Continued on Reverse Side
S:\FormsLib\Civil Bureau\Civ Fam Intake & Customer Svc\Civintake\Protective Order TCIC Data Entry Form Created 2/7/96

TCIC DATA ENTRY FORM FOR PROTECTIVE ORDERS PAGE TWO

RESPONDENT'S NAME: ______________________________________

***PROTECTIVE PERSON INFORMATION***

NAME OF PROTECTED PERSON: _________________________________________________ RACE: (circle one) Indian Asian Black White Unknown Ethnicity:
(circle one)

SEX:

(circle one)

M

F

Hispanic

Non-Hispanic

Unknown

DATE OF BIRTH: ____________ Address: _______________________________________ City: _______________________ State: ____________________________ Zip: ____________________ COUNTY: ____________________________________ Protected Person Employment Information: (use additional pages if necessary) Place of Employment Name: ______________________________________ Address: _________________________________ _____________________________________ City: ___________________ State: __________________ Zip: ___________

Place of Employment Name: ______________________________________ Address: _________________________________ _____________________________________ City: ___________________ State: __________________ Zip: ___________

***PROTECTED CHILD INFORMATION***
(Use additional pages if necessary) Name of Protected Child: ___________________________________________________________ Race: (circle one) Indian Asian Black White Unknown Ethnicity:
(circle one)

SEX:

(circle one)

M

F

Hispanic

Non-Hispanic

Unknown

Date Of Birth: ____________ Child Care or School Facility Name: ________________________________________________ Address: _________________________________________ City ________________ State: ___________ Zip ____________

Name of Protected Child: ___________________________________________________________ Race: (circle one) Indian Asian Black White Unknown Ethnicity:
(circle one)

SEX:

(circle one)

M

F

Hispanic

Non-Hispanic

Unknown

Date Of Birth: ____________ Child Care or School Facility Name: ________________________________________________ Address: _________________________________________ City ________________ State: ___________ Zip ____________

Name of Protected Child: ___________________________________________________________ Race: (circle one) Indian Asian Black White Unknown Ethnicity:
(circle one)

SEX:

(circle one)

M

F

Hispanic

Non-Hispanic

Unknown

Date Of Birth: ____________ Child Care or School Facility Name: ________________________________________________ Address: _________________________________________ City ________________ State: ___________ Zip ____________

Name of Protected Child: ___________________________________________________________ Race: (circle one) Indian Asian Black White Unknown Ethnicity:
(circle one)

SEX:

(circle one)

M

F

Hispanic

Non-Hispanic

Unknown

Date Of Birth: ____________ Child Care or School Facility Name: ________________________________________________ Address: _________________________________________ City ________________ State: ___________ Zip ____________

TEXAS DEPARTMENT OF PUBLIC SAFETY (JANUARY 2096)
Page 2 of 2
S:\FormsLib\Civil Bureau\Civ Fam Intake & Customer Svc\Civintake\Protective Order TCIC Data Entry Form Created 2/7/96