Laserfiche WebLink
i <br /> 2. I understand that my decision to allow release of the data described herein to <br /> is voluntary. <br /> 3. The specific data that I want the City of Pequot Lakes to release to the entities or <br /> person(s) specified herein is described as follows: <br /> 4. I understand that although the da.ta,requested and to be released are classified as private <br /> or confidential at the City of Pequot Lakes,the classification/treatment of the da.ta.at the <br /> City of Pequot Lakes depends on laws or policies that apply to and govern the City of <br /> Pequot Lakes and its custody,possession, control, and release thereof. <br /> This authorization to release the data.described herein expires on ,20 <br /> Having been informed of and understanding all of my rights, I hereby authorize and agree to <br /> allow the City of Pequot Lakes to release the above-described private da.ta to the entities or <br /> person(s) identified herein, and expressly release any person in the City of Pequot Lakes from <br /> any and all legal liability for making disclosure of any information about me,which it is <br /> permitted by law, either with my permission or without my permission,to release. <br /> (Signature of individual authorizing release) Date <br /> (Parent/Guardian Signature [if needed] Date <br /> STATE OF ) <br /> ) ss. <br /> COUNTY OF ) <br /> Subscribed, sworn to and acknowledged before me by <br /> this day of , 20 <br /> (seal) <br /> Signature of Notary Public <br /> Informed Consent Page 2 <br />