Appraisal Management Company Registration Application Page 9
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10AUTHORIZATION FOR RELEASE OF INFORMATION
I, _______________________________________________________________________________________
NAME (MUST BE PRINTED-LEGIBLY)
(SSN #)
(DOB)
________________________________________________________________________________________
(AMC Name)
PURSUANT TO NMSA 1978, SECTION 29-10-6(A) (Repl. Pamp. 1990), OF THE NEW MEXICO ARREST
RECORD INFORMATION ACT, HEREBY APPOINT:
New Mexico Real Estate Appraisers Board, 2550 Cerrillos Road, Santa Fe, New Mexico 87504
AS AN AUTHORIZED AGENT FOR ME FOR THE PURPOSE OF INSPECTING (AND/OR OBTAINING
COPIES OF) ANY NEW MEXICO ARREST FINGERPRINT CARD SUPPORTED ARREST RECORD
INFORMATION MAINTAINED BY THE DEPARTMENT OF PUBLIC SAFETY, INCLUDING
INFORMATION CONCERNING FELONY OR MISDEMEANOR ARRESTS AND INFORMATION
OBTAINED FROM RELEVANT FINGERPRINT DATABASES.
TO THE CUSTODIAN OF THE RECORDS IN QUESTION, I HEREBY DIRECT YOU TO RELEASE SUCH
INFORMATION TO THE AUTHORIZED AGENT AS DESCRIBED ABOVE.
I HEREBY RELEASE THE CUSTODIAN OR CUSTODIANS OF SUCH RECORDS AND THE DEPARTMENT
OF PUBLIC SAFETY, INCLUDING ANY OF THEIR AGENTS, EMPLOYEES, OR REPRESENTATIVES IN
ANY CAPACITY, FROM ANY AND ALL CLAIMS OF LIABILITY OR DAMAGE OF WHATEVER KIND OR
NATURE, WHICH AT ANY TIME COULD RESULT TO ME, MY HEIRS, ASSIGNS, ASSOCIATES,
PERSONAL REPRESENTATIVE OR REPRESENTATIVES OF ANY NATURE BECAUSE OF COMPLIANCE
BY SAID CUSTODIAN OR CUSTODIANS WITH THIS "AUTHORIZATION FOR RELEASE OF
INFORMATION" AND MY REQUEST CONTAINED HEREIN FOR THIS RELEASE OR BECAUSE OF ANY
USE OF THESE RECORDS. THIS RELEASE IS BINDING, NOW AND IN THE FUTURE AND IS VALID
FOR A PERIOD OF UP TO 120 DAYS FROM THE DATE SIGNED, ON MY HEIRS, ASSIGNS, ASSOCIATES,
PERSONAL REPRESENTATIVE OR REPRESENTATIVES OF ANY NATURE.
APPLICANT SIGNATURE: ____________________________________ DATE: _________________________
(*ATTN NOTARY: ENSURE DOCUMENT IS SIGNED BY IN YOUR PRESENCE AND NAME, DOB,
SOC INFO IS VERIFIED WITH A VALID ID)
SUBSCRIBED AND SWORN TO BEFORE ME THIS _______ DAY
OF_____________, 20_______.
For Department Use Only
(SEAL) _________________________________________.
(NOTARY PUBLIC)
MY COMMISSION EXPIRES: _____________________.
MAIL DIRECTLY TO:
New Mexico Department of Public Safety
Attn: Records, P.O. Box 1628
Santa Fe, NM 87504-1628 ($15.00 PER RECORD CHECK)
Appraisal Management Company Registration Application
(Rev. 07/2015)
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