Authorization To Release Applicant Information To A Third Party - Minnesota Board Of Accountancy

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M
B
a
Ph: 651-296-7938
innesota
oard of
ccountancy
Fax: 651-282-2644
85 East 7th Place, Suite 125
boa.state.mn.us
St. Paul, MN 55101-2143
AUTHORIZATION TO RELEASE
APPLICANT INFORMATION
TO A THIRD PARTY
THIS FORM IS NOT REQUIRED
CLEAR
CLEAR
Only complete this optional form if you intend someone other than yourself to
FORM
FORM
contact the Board regarding the status of your application.
Minnesota law prohibits the Board from sharing any information regarding
anyone
your application (prior to final licensure) with
other than yourself
unless you submit this authorization.
AUTHORIZATION/RELEASE
Applicant data is classified as private or confidential under the Minnesota Data
I hereby waive my rights under the Minnesota Data
Practices Act. However,
Practice Act
and authorize the Minnesota Board of Accountancy to provide
information contained in my application materials, including any documents, to
the following individual:
Provide first and last name of third party who may receive information.
I understand that I am not legally required to sign this form. The purpose of this
authorization is to facilitate the processing of my application. This authorization
automatically expires one year after this date.
Printed Name of Applicant
Date
Applicant Signature
Authorization for Release of Information—FORM

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