County Record Release Authorization Form

County Record Release Authorization Form
Authorize the release of specific county records by completing all required fields below. Please ensure all information is accurate to avoid processing delays.
Applicant Full Name
First NameLast Name
Applicant Email Address
example@example.com
Applicant Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Applicant Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Recipient/Agency Name (Who will receive the records?)
Recipient/Agency Email
example@example.com
Type of County Records to be Released
Other
Purpose of Record Release
Authorization Valid Until
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Applicant's Relationship to the Records
Authorization and Signature: By signing below, I authorize the release of the specified county records to the recipient/agency listed above.
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