Personal Data Questionnaire
This form is designed for Custodial Care Givers to provide, in advance, certain information that will be useful to Search
Teams, should the need arise. Providing the information in advance of the need will allow Search Management Personnel to
do their job faster, when needed.
Resident: __________________________________________________________________________
Address: ___________________________________________________________________________
City/State: ___________________________________________ Zip: __________________________
Phone: __________________________
Date Transmitter Placed: ___________________________
Facility/Organization: ___________________________________ Phone: _______________________
Address: ___________________________________________________________________________
Name of Person filling out this form: ____________________________________________________
Resident’s Personal Data
Birthdate: _____________________________ Sex: M / F Race: _____________________________
Nickname(s): _______________________________________________________________________
Most Recent Address: ________________________________________________________________
Most Recent Place of Work: ___________________________________________________________
Most Recent Occupation: _____________________________________________________________
Name of Spouse: ______________________________________ Living / Deceased (circle)
Family/Friend Information
Other persons the resident may contact (family, friends, etc.)
Name: ___________________________ Address: _________________________________________
Phone: ___________________________
Name: ___________________________ Address: _________________________________________
Phone: ___________________________
Tuscaloosa County Sheriff’s Office
Project Lifesaver
Alabama
WINSTON COUNTY SHERIFF’S OFFICE
Winston County Alabama
ED TOWNSEND
Physical Description
Height ______ft, _______in. Weight________ lbs.