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Authorization For The Release Of Information Re Application To Restore Right To Purchase Posses Or Transport A Firearm PC-150 - Connecticut
| Authorization For The Release Of Information Re Application To Restore Right To Purchase Posses Or Transport A Firearm Form. This is a Connecticut form and can be used in Probate Statewide . |
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AUTHORIZATION FOR THE RELEASE OF INFORMATION RE APPLICATION TO RESTORE RIGHT TO PURCHASE, POSSESS OR TRANSPORT A FIREARM, P.A. 11-134 STATE OF CONNECTICUT COURT OF PROBATE RECORDED (CONFIDENTIAL VOLUME): PC-150 NEW 7/11 TO: COURT OF PROBATE, DISTRICT NO. IN RE [Petitioner's Name, address, date of birth, social security number and telephone number] I, the undersigned person or legal representative, hereby authorize the release of the following records related to my application for restoration of my right to purchase, possess or transport a firearm under P.A. 11-134 to the Commissioner of Public Safety: health records mental health records military records immigration records Probate Court records Juvenile Court records Civil Court records Criminal Court records other [specify] I authorize the Commissioner of Public Safety to obtain any of the records listed above for use at a Probate Court hearing or in any appeal from the decision of the Probate Court. DATE Petitioner's Signature AUTHORIZATION FOR THE RELEASE OF INFORMATION RE APPLICATION TO RESTORE RIGHT TO PURCHASE, POSSESS OR TRANSPORT A FIREARM, P.A. 11-134 PC-150 NEW 7/11 American LegalNet, Inc. www.FormsWorkFlow.com
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