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Consent To Release Of Information - California
|Consent To Release Of Information Form. This is a California form and can be used in Family Humboldt Local County .||
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HUMBOLDT COUNTY TRIAL COURT RULES Appendix 9.4 CONSENT TO RELEASE OF INFORMATION To Whom it May Concern: This is to inform you that at no expense to the undersigned, you are authorized to release to my spouse or to my spouse's attorney of record upon request, information which you may possess and which they might deem material as to the matters hereof specified () () Wage records Records relating sharing benefits to retirement pension, or profit () () Records relating to insurance policies Records relating to health care benefits This authorization is intended to extend to the right to observe, make excerpts from or make photocopies of, at their discretion, any records to which I would be entitled which otherwise would be considered confidential. This authorization shall apply for a time period of one year from the date appearing hereon unless sooner revoked by my written notice to you to that effect. Dated: Signature I am the spouse of immediately above. I am: () () Representing myself Represented by: the person whose signature appears Please send the records designated above to the following address: Dated: Signature (36) 2000 (C) American LegalNet, Inc.