Victim Identification Program. Missing Person Family Interview

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1 Victim Identification Program Missing Person Family Interview June 2012

2 VIP Personal Information Page 1 of 8 Name Sex If FemaleMaiden Name Age DOB MMDDYYYY Race Ethnic Origin Ethnic Origin SSN # ID # Address Apt # City State Zip County Country Birth City State or Country Birth Hospital Education: level completed: ElemSecond (0-12): College Inside City Limits Degree Earned: Religious Preference Alias 1 Alias 2 Phone(H) (W) (Cell) Cell Type: Carrier: Status Is Married Never Married Widowed Divorced Separated Civil Union k Wedding Date Spouse Living Deceased Unknown Maidenbirth Name Father Living Deceased Unknown Mother Living Deceased Unknown MaidenBirth Name Legal Next of Kin Informant , Address City State Zip Home Phone Work Phone Cell Phone Type of Initial Contact OK to Contact Legal Next of Kin? Address Home,, Work Initial Contact Date City State Zip Cell Phone Country Make A Case te To Explain Country Relationship Relationship Spouse Father Mother Brother Sister Son : Spouse Father Mother Brother Sister Son : Daughter Uncle Aunt Cousin Employer Friend Daughter Uncle Aunt Cousin Employer Friend Life Partner Life Partner 1 Contacts Permanent Contact: YES Additional Contact? Home Phone Work Phone Cell Phone YES Address City State Zip Relationship Spouse Father Mother Brother Sister Son : Daughter Uncle Aunt Cousin Employer Friend Life Partner Type of Initial Contact Initial Contact Date

3 VIP Physical Page 2 of 8 Complextion: Height Inches: General Build: Age DOB Sex Race Height cm Approx. Weight (Pounds): Weight Kilos H a i r I n f o E y e s N a i l s Hair Color Hair Length Facial Hair Type Facial Hair Color Eye Color Blue Brown Green Hazel Gray Black : Eye Status Auburn Black Hair Accessory Extensions Hair Piece Hair Transplant Wig NA Hair Curly Wavy Straight NA : Optical Lens Fingernail Type Fingernail Color Toenail Color Bald Shaved Auburn Black Blonde Brown Short < 3" Medium Clean Shaven Mustache Blonde Brown Gray Red Both Intact Missing R Missing L Glass R Glass L Cataract Contacts Glasses Implants ne Optical Color of Glasses Contacts: Natural Artificial Unknown Beard & Mustache Beard Gray Red Sald and Pepper White Male Pattern Baldness: Long Sald and Pepper White Toenail Type Natural Artificial Unknown Length Toenail description Dyed Goatee Stubble Desc. Dyed Describe : Describe Male Pattern Baldness: Sideburns Lower Lip NA Facial Hair tes: Extremely Long Long Medium Short Body Piercing(s)? Photos? # Location Side Quantity (include evidence of old piercings) Photo # Tattoo(s) Photos? Location Side Tattoo Photo Location Photo Location

4 VIP Medical History Page 3 of 8 Dentist Dentist Age DOB Sex Race Name of Practice: Address City State Zip Sal Address: Phone W Alt: Fax 2nd Dentist: Dental Insurance Company: Braces Bridge CapsCrowns Fillings Dentures Edentulous Tooth Jewelry Unknown Doctor Physician Address City State Zip Phone W Phone H, Sal. Practice Name Physician Type Reason Seen: Date Seen: Phone C Fax Doctor Physician Address City State Zip Phone W Phone H, Sal. Practice Name Physician Type Reason Seen: Date Seen: Phone C Fax Medical Facility Visited Type? Medical History? Cancer High Blood Pressure Lung Disease Pregnancy Stroke Medical History tes? Medical Radiographs? Medical Radiographs Location: Potential Type of Radiographs - and dates taken if known: Medical Facility Name Old Fractures: Foreign Objects : Describe : Surgery: Unk Gall Bladder Appendectomy Tracheotomy : Pacemaker Bullets Implants Needles Shrapnel Laparotomy Caesarean Mastectomy Reconstructive Open heart Unique Characteristics of: Scars or unusual body features: Prosthetic(s) Prosthetic Location Circumcised? Tobacco User? Tobacco Type? Diabetic? If Female, was she currently pregnant? If Female, was she pregnant during the last 12 months?

5 VIP Personal Information Page 4 of 8 GROUP TRAVEL INFORMATION Traveling with: Alone Individual Group Date last seen? seen by? Age DOB Sex Race Group Type: Family, Sports, Church, Military, etc. Family or Group Name: seen with: location Victim was seen: MILITARY INFORMATION Military Service DNA Taken: Criminal History: Ever Printed: Nation Served Print Types: Branch Comments regarding Military History: CRIMINAL HISTORY OR FINGER PRINT INFORMATION Date of Arrest: Date Released: Location of Prints: Service Number Arrested By: Approximate Service Date Prison or Jail Location: EMPLOYMENT HISTORY Work Status: Type of Business Industry: Employer Address: ADDITIONAL PERSONAL DATA List memberships: Clubs, Fraternities, etc. Usual OccupationTitle: Employer: Employer Phone: List Social Media used and user names: (Facebook, Twitter etc.) Additional Data:

6 VIP Jewelry Page 5 of 8 Age DOB Sex Race rmally wears a Watch: Type Make Band Material Band Color Face Color Where Worn? WATCH: Unk 1 JewelryType Material Color Size Where Worn 2 JewelryType Material Color Size Where Worn 3 JewelryType Material Color Size Where Worn JEWELRY: 4 5 JewelryType JewelryType Material Color Material Color Size Where Worn Size Where Worn 6 JewelryType Material Color Size Where Worn 7 JewelryType Material Color Size Where Worn

7 VIP Clothing and Personal Effects Page 6 of 8 Age DOB Sex Race Clothing Items Color Size CLOTHING: Wallet: Purse: Contents Contents Contents Left Contents Right

8 VIP Family Page 7 of 8 Age DOB Sex Race Potential Living Biological Donors All BIOLOGICAL Relatives of Missing Individual Such as: MotherFatherSpouseSisterBrotherChildrenUncleAuntCousin Are we Collecting Family Reference DNA Name Name Name SS# 4 DOB Sex Relationship Name Name Name SS# 4 DOB Sex Relationship Name Name Name SS# 4 DOB Sex Relationship Name Name Name SS# 4 DOB Sex Relationship Name Name Name SS# 4 DOB Sex Relationship Name Name Name SS# 4 DOB Sex Relationship Name Name Name SS# 4 DOB Sex Relationship Name Name Name SS# 4 DOB Sex Relationship Primary donor for Nuclear DNA Analysis An appropriate family member for nuclear DNA Analysis is someone who is biologically related to and only one generation removed from the deceased. The following are the family members who are appropriate donors to provide reference specimens, and in the order of preference (family members highlighted in bold print are the most desirable): 1. Natural (Biological) Mother and Father, AND 2. Spouse and Natural (Biological) Children, AND 3. A Natural (Biological) Mother or Father and victim s biological children, OR 4. Multiple Full Siblings of the Victim (i.e., children from the same Mother and Father).

9 VIP Interviewer Information Page 8 of 8 Name Interview Location Date Interviewer Name Interviewing Agency (MMDDYYYY) Full Name Time Interviewer Home Information City: Home Phone: Cell Phone: Work Phone: Interviewer Onsite Information Interviewer Onsite address: Location Name and Street,City. State and Room # Interviewer Onsite phone: Interviewer Onsite cell: Reviewer Info Reviewer Name: Reviewing Agency: Reviewer s Signiture:

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