ATTN:  Records

Sumter County Sheriff’s Department

P.O. Box 188

Bushnell, FL  33513

Dear Sirs,

Pursuant to Chapter 435, F.S., SCARC, Inc. requests a local records check on the applicant/employee listed below:

Last Name:                First Name:                Middle Name:

______________     _______________  ___________

Date of Birth:             Race:                          Sex:                            Social Security

__________              _______________  ___________                       ____________

Please document the findings on this check and return the information to:

SCARC, Inc.

213 West McCollum Avenue

Bushnell, FL  33513

Sincerely,

Marsha Woodard Perkins

Executive Director