Sample Authorization To Release Information - Bureau Of Engraving And Printing printable pdf download

Sample Authorization To Release Information - Bureau Of Engraving And Printing

Sample: Authorization to Release Information

In accordance with the Privacy Act of 1974 (5 U.S.C. 552a, Public Law 93-579),

I, _________________________________________________, hereby request and give my consent

to the Bureau of Engraving and Printing to release the information described below to:

Name _____________________________________________

Address _____________________________________________________________________

I understand that by signing this document, I authorize the release of the following information:

Description of Information

Signature:_____________________________________________ Date: _________________________

Sample Authorization To Release Information - Bureau Of Engraving And Printing