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180
Appendix - Form 180-1 Notification of Request for Information
Procedures
Notification of Request for Information
To: _______________________________________________________________
This is to advise that _________________________________________________
Has requested information in regards to the following items:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Before this information is to be released, you must supply the Division with the authorization to do so. In the consent form below, please signify if any specific information is not to be released.
_____________________________________ ___________________________
Officer of the Division Date
Authorization for Release of Information
I, ___________________________ , hereby authorize the above-noted officer of the Division to release information in regards to the items stated above except for (if any).
__________________________________________________________________
__________________________________________________________________
_____________________________________ ___________________________
Signature Date
Validity of this authorization expires after 90 days from this date.
References:
Revised January 2014