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R-84 (Rev. 5-14-80) FINAL DISPOSITION REPORT Leave Blank Note: This vital report must be prepared on each individual whose arrest fingerprints have been forwarded to the FBI Identification Division without final disposition noted thereon. if no final disposition is available to arresting agency, also obtain subject's right four finger impressions on this form, complete left side and forward the torm when cas2 referred to prosecutor and/or courts. Agency on notice as to final disposition should complete this form and submit to: Director, FBL, Washington, D.C. 20537, Attention: Identification Division. (See instuctions on reverse side} FBINo. Final Disposition & Oate {if convicted or subject pleaded guilty tolesser charge, include this modification with dispostion.) Name on Fingerprint Card Submitted to FBI Last First Middle | Date of Birth, Se: Henry Fingerprint Classification From FBI 1-8 Response State Bureau No. (SID) Social Security No. {SOC} This Form Submitted By: (Name, Title, Agency, ORI No., City & State) Contributor of Fingerprints (Include complete name and location of agency, together with ORI number.} Signature Date Tite ‘Arrest No. (OCA) Date Arrested or Received 0 COURT ORDERED EXPUNGEMENT: Return Arrest Fingerprint Card to Contributing Agency: Certified or Authenticated Copy of Court Order Attached Offenses Charged at Arrest Right Four Fingers Taken Simultaneously Itadditional space is needed, check C) and continue on reverse side of this form. FBI(19-cv-1495)-2095 i oo