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Oregon State Police Copy of Own Record / Clearance Letter Request COPY OF OWN RECORD / CLEARANCE LETTER REQUEST FORM I Revised 2022-12 The Oregon Copy of Own Record/Clearance Letter is the result of a fingerprint-based background check. Complete the following steps to obtain a copy of your own Oregon Criminal History report or Clearance Letter indicating that you have no Oregon Criminal History: 1. Obtain properly rolled set of your fingerprints using the blue applicant fingerprint card (FD258). An example of this fingerprint card is available at: To help avoid rejection or delays, please ensure the 6 required fields on the fingerprint card are complete. Your printed name, your signature, date of birth, gender, race, and the Fingerprint Agencies signature are required fields. Your fingerprint card will be returned with your response. 2. Submit your completed request form along with your fingerprint card and payment to OSP. If submitting by mail, send your completed form, fingerprint card and check or money order to: Oregon State Police CJIS Division Unit 11 P.O. Box 4395 Portland, OR 97208-4395 Due to the confidentiality of the criminal history information, results will only be mailed to the subject of the Copy of Own Records request. OSP will not send results to attorneys, employers, schools, etc. Fingerprinting Services: The Oregon State Police offers public fingerprinting services at our Salem General Headquarters. This is a walk- in only service available Monday-Friday 8am to 4:30pm, excluding holidays. Valid government issued photo identification is required. We accept checks, money orders, cash and all major credit cards except American Express. Checks and money orders must be made payable to Oregon State Police. OSP General Headquarters are located at: 3565 Trelstad Ave SE Salem, OR 97317 Fees: For more information or questions, please contact the COR/Open Records unit. Phone: [PHONE REDACTED] Email: [EMAIL REDACTED] Service Type Fee Copy of Own Record/Clearance Letter $33 Public Fingerprinting $30 Notary Service for Copy of Own Record $5 per copy ---PAGE BREAK--- Oregon State Police Copy of Own Record / Clearance Letter Request COPY OF OWN RECORD / CLEARANCE LETTER REQUEST FORM I Revised 2022-12 This form is to be used to request a copy of your own Oregon Criminal History or Clearance Letter information. This is an Oregon only request and the results will only include information for Oregon. This record is based on your fingerprints provided. The results will only be mailed to the subject of the “Copy of Own Record” request. This form may be copied. Subject: Last name First name Middle name Suffix Other Names Used: Date of Birth: Social Security Number: Mailing Address: City: State: Zip Code: Country: Telephone: Email Address: ****Email is required if mailing out of the United States; We do not make calls outside the I would like to pick up my results at OSP General Headquarters (ID required) ☐ Payment Information: $33.00 Check/Money Order included ☐ $5.00 Notarized Response Requested ☐ Note: Checks and money orders must be made payable to Oregon State Police. Total Included Signature Date