Common use of AUTHORIZATION TO RELEASE CONFIDENTIAL INFORMATION Clause in Contracts

AUTHORIZATION TO RELEASE CONFIDENTIAL INFORMATION. THE XXXXXXXXX XXXXXXX XXXXXX XXXXXXX XXXXXXX, XX. JUVENILE JUDGE CHIEF JUVENILE OFFICER 65th DISTRICT COURT JUVENILE PROBATION DEPARTMENT EL PASO COUNTY EL PASO COUNTY Name: Date of Birth: Social Security Number: I authorize the release of all confidential records and information pertaining to TCIC/NCIC Records / Police / Records / Sheriff’s Records concerning myself to the 65th Judicial District Court and to the El Paso County Juvenile Probation Department. Signature Date REQUESTED BY: APPROVED: DIRECTOR DATE REQUESTED: Criminal Records Check Requested on: NAME DOB SSN 1.

AUTHORIZATION TO RELEASE CONFIDENTIAL INFORMATION. THE XXXXXXXXX XXXXXXX XXXXXX XXXXXXX XXXXXXX, XX. XXXX XXXXXXXXX XXXXX XXXXXXXX JUVENILE JUDGE CHIEF JUVENILE OFFICER 65th DISTRICT COURT JUVENILE PROBATION DEPARTMENT EL PASO COUNTY EL PASO COUNTY Name: Date of Birth: Social Security Number: I authorize the release of all confidential records and information pertaining to TCIC/NCIC Records / Police / Records / Sheriff’s Records concerning myself to the 65th Judicial District Court and to the El Paso County Juvenile Probation Department. Signature Date REQUESTED BY: APPROVED: DIRECTOR DATE REQUESTED: Criminal Records Check Requested on: NAME DOB SSN 1.

AUTHORIZATION TO RELEASE CONFIDENTIAL INFORMATION. THE XXXXXXXXX XXXXXXX XXXXXX XXXXXXX XXXXXXX, XX. X. XXXXXXXXX XXXXX XXXXXXXX JUVENILE JUDGE CHIEF JUVENILE PROBATION OFFICER 65th DISTRICT COURT JUVENILE PROBATION DEPARTMENT EL PASO COUNTY EL PASO COUNTY JUVENILE PROBATION DEPARTMENT Name: Date of Birth: (PRINT NAME) Social Security Number: I authorize the release of all confidential records and information pertaining to TCIC/NCIC Records / Police / Records / Sheriff’s Records concerning myself to the 65th Judicial District Court and to the El Paso County Juvenile Probation Department. Signature Date REQUESTED BY: APPROVED: DIRECTOR PURPOSE: COMPLIANCE CONTRACTUAL REQUIREMENT DATE REQUESTED: Criminal Records Check Requested on: NAME DOB SSN 1.

AUTHORIZATION TO RELEASE CONFIDENTIAL INFORMATION. THE XXXXXXXXX XXXXXXX XXXXXX XXXXXXX XXXXXXX, XX. X. XXXXXXXXX XXXXX XXXXXXXX JUVENILE JUDGE CHIEF JUVENILE PROBATION OFFICER 65th DISTRICT COURT JUVENILE PROBATION DEPARTMENT EL PASO COUNTY EL PASO COUNTY JUVENILE PROBATION DEPARTMENT Name: Date of Birth: (PRINT NAME) Social Security Number: I authorize the release of all confidential records and information pertaining to TCIC/NCIC Records / Police / Records / Sheriff’s Records concerning myself to the 65th Judicial District Court and to the El Paso County Juvenile Probation Department. TCIC/NCIC/Police/Sheriff’s Records Signature Date REQUESTED BY: APPROVED: DIRECTOR PURPOSE: COMPLIANCE CONTRACTUAL REQUIREMENT DATE REQUESTED: Criminal Records Check Requested on: NAME DOB SSN 1.

AUTHORIZATION TO RELEASE CONFIDENTIAL INFORMATION. THE XXXXXXXXX XXXXXXX XXXXXX XXXXXXX XXXXXXX, XX. JUVENILE JUDGE CHIEF JUVENILE OFFICER 65th DISTRICT COURT JUVENILE PROBATION DEPARTMENT EL PASO COUNTY EL PASO COUNTY Name: Date of Birth: Social Security Number: I authorize the release of all confidential records and information pertaining to TCIC/NCIC Records / Police / Records / Sheriff’s Records concerning myself to the 65th Judicial District Court and to the El Paso County Juvenile Probation Department. Signature Date REQUESTED BY: APPROVED: DIRECTOR DATE REQUESTED: Criminal Records Check Requested on: NAME DOB SSN 1.: