Complete this portion ONLY if an FBI Background Check is needed:
I certify that the personal identifiers provided on this form are accurate and I voluntarily and knowingly authorize the Ohio Bureau of Criminal Identification & Investigation to conduct a criminal records check for the information relating to me. I also voluntarily and knowingly authorize BC&I to disseminate criminal arrest, conviction and juvenile delinquency adjudication records to Blended Family. I voluntarily and knowingly release and discharge the Ohio Attorney General's Office, BC&I and their employees from all claims and liability related to this authorized criminaL record review and dissemination.
By signing this form the applicant acknowledges that all information on this form is accurate. Any mistakes or errors on this form are the responsibility of the applicant.
