NOTICE: You may cancel this request at any time prior to the release of information. In any
event, this consent form will expire 90 days after submitting.
After being shown private data on individuals and informed of its meaning, this data need not be
disclosed again for six months unless additional information has been collected or an action is
NOTE: The subject of the data request must authorize the release of private information to the
subject’s agent or another agency. An “Informed Consent to Release” must be completed by the
subject of the data.
Please be as specific as possible.
You may be required to pay the actual costs of making and/or compiling data. Fees will be determined following the submission of this request.
This field is not part of the form submission.
* indicates a required field