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General Release Authorization - Ohio
| General Release Authorization Form. This is a Ohio form and can be used in Citizen Protection Attorney General Office Statewide . |
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GENERAL RELEASE AUTHORIZATION To all Courts, Probation Departments, Selective Service Boards, Credit Bureaus, Employers, Educational Institutions, Banks, Financial and Other Such Institutions, and all Governmental Agencies (federal, state and local without exception both foreign and domestic): I, _________________________________________, as an owner, officer, director, partner, stockholder or key employee of an applicant for or holder of an Ohio Environmental Protection Agency solid, infectious, or hazardous waste license, or permit, have authorized the Attorney General of Ohio to conduct an investigation into my background for the purpose of determining the suitability of the company with which I am affiliated to hold a solid, infectious, or hazardous waste license, or permit, as provided under Sections 3734.40 - .47 of the Ohio Revised Code. Therefore, you are hereby authorized to release any and all information pertaining to me, documentary or otherwise, as requested by an appropriate employee, agent or representative of the Attorney General. This authorization shall supersede and countermand any prior request or authorization to the contrary. A copy of this authorization will be considered as effective and valid as the original. _______________________________________ Signature ____________________________ Date Sworn to and subscribed before me this _____ day of ____________________________, 200__. __________________________________________ NOTARY PUBLIC My Commission Expires:_____________________ Under Ohio Revised Code 2921.11 and 2929.11, perjury is a felony of the third degree; punishable by imprisonment for one to ten years and a fine up to $5,000. Under Ohio Revised Code 2921.13 and 2929.21, falsification is a misdemeanor of the first degree; punishable by imprisonment for six months and a fine up to $1,000. American LegalNet, Inc. www.FormsWorkflow.com
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