Quick Retrieval Fact Sheet

Quick Retrieval Fact Sheet
Issuing Office*

Oklahoma CityTulsaLawton
Preparer's Name*
Preparer's Email*
Enter Date

MonthDayYear
Applicant's First Name
Last Name
Nickname
Date of Birth

MonthDayYear
Admission Date

MonthDayYear
Medical Number
KK Number
Social Security #
Birth City
Birth St
School
Grade
Race
Religion
Hair Color
Eye Color
Gender

MaleFemale
Height Feet
Height Inch
List any scars, birthmarks or tattoos:
Use the buttons below to take pictures of scars, birthmarks, tattoos, etc.

Brothers and Sisters (Siblings) Name and Ages

	Relationship	Name	Age
Sibling #1
Sibling #2
Sibling #3
Sibling #4
Sibling #5
Sibling #6

Father's First Name
Last Name
Date of Birth

MonthDayYear
Father's Address - Street
City
ST
Zip
County
Home Phone #
Work Phone #
Cell Phone #
Text Message OK

NoYes
Father's Email
example@example.com
Mother's First Name
Last Name
Date of Birth

MonthDayYear
Mother's Address - Street
City
ST
Zip
County
Home Phone #
Work Phone #
Cell Phone #
Text Message OK

NoYes
Mother's Email
example@example.com