Parental Consent And Authorization For Release Of Information In The Possession Of The City Of Troy Police Department And For The Fingerprinting Of A Minor For Investigation Under Application Form For A Peddler'S License printable pdf download

Parental Consent And Authorization For Release Of Information In The Possession Of The City Of Troy Police Department And For The Fingerprinting Of A Minor For Investigation Under Application Form For A Peddler'S License

PARENTAL CONSENT AND AUTHORIZATION FOR RELEASE OF

INFORMATION IN THE POSSESSION OF THE CITY OF TROY POLICE

DEPARTMENT AND FOR THE FINGERPRINTING OF A MINOR FOR

INVESTIGATION UNDER APPLICATION FOR A PEDDLER’S LICENSE

I, _______________________________, am the parent or legal guardian

of__________________________, date of birth:___________.

I have been

informed that __________________________has submitted a Peddler’s License

Application on behalf of my child so that my child can solicit business for that

individual and/or company by going door-to-door in the City of Troy. I represent

to the City of Troy that I consent to allow this child to work for that

individual/company and solicit door-to-door. I consent to and hereby authorize

the release of any and all of this child’s criminal history or any information in

possession of the Troy Police Department to the City Clerk’s Office for issuance

of a Peddler’s License and to the public under the Freedom of Information Act, as

part of the investigation for a Peddler’s License. This information may include,

but is not limited to, arrests and/or convictions under juvenile proceedings,

arrests and/or convictions for a child over the age of 17, and/or any other

information such as witnesses’ statements and police reports, which are or may

come into the possession of the Troy Police Department.

I also consent to and authorize the Troy Police Department to fingerprint

this child and enter those fingerprints into the LiveScan equipment, which will

result in submittal of those fingerprints to the Michigan State Police and other law

enforcement agencies in the United States.

A WORK LICENSE WILL BE REQUIRED, IF APPLICABLE.

THIS CONSENT AND AUTHORIZATION MUST BE SIGNED IN THE

PRESENCE OF A NOTARY PUBLIC AND THE PARENT OR GUARDIAN

MUST PRESENT PHOTO IDENTIFICATION OF THEMSELVES

AND A COURT ORDER IF GUARDIAN

Date: _____________

Signature: _________________________

Print Name:________________________

On this______day of______________, 20____, before me personally appeared

________________________________known by me to be the same person

who signed this Consent and Authorization and who acknowledged this to be

his/her free act and deed.

Signature::________________________________

Print Name:_______________________________

NOTARY PUBLIC, ______________County, Michigan

My commission expires:________________

Parental Consent And Authorization For Release Of Information In The Possession Of The City Of Troy Police Department And For The Fingerprinting Of A Minor For Investigation Under Application Form For A Peddler'S License

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