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VOLUNTEER NAME
I HEREBY AUTHORIZE ANY POLICE OFFICER OR OTHER REPRESENTATIVE OF THE ROSWELL POLICE DEPARTMENT BEARING THIS RELEASE OR A COPY THEREOF, WITHIN ONE YEAR OF THE DATE INDICATED BELOW, TO OBTAIN INFORMATION CONTAINED IN ANY FILE, COMPUTER BANK, OR OTHER COMPILATION SYSTEM RELATING TO CRIMINAL HISTORY INFORMATION MATTERS. THIS WAIVER EXTENDS TO ANY AND ALL INFORMATION PROCESSED BY LOCAL, STATE OR FEDERAL LAW ENFORCEMENT AGENCY WHICH RETAINS CRIMINAL HISTORY INFORMATION.
I HEREBY DIRECT YOU TO RELEASE THIS INFORMATION UPON REQUEST OF THE BEARER. THIS RELEASE IS EXECUTED WITH FULL KNOWLEDGE AND UNDERSTANDING THAT THE INFORMATION IS FOR THE OFFICIAL USE OF THE ROSWELL POLICE DEPARTMENT.
CONSENT IS GRANTED FOR THE ROSWELL POLICE DEPARTMENT TO FURNISH THE INFORMATION DESCRIBED ABOVE TO THIRD PARTIES IN THE COURSE OF FULFILLING ITS OFFICIAL RESPONSIBILITIES.
I HEREBY RELEASE YOU, AS THE CUSTODIAN OF SUCH RECORDS, AND AN SCHOOL, COLLEGE, UNIVERSITY OR OTHER EDUCATIONAL INSTITUTION, FORMER EMPLOYER OF ANY CAPACITY, LAW ENFORCEMENT AGENCY, INCLUDING ITS OFFICERS, EMPLOYEES, OR RELATED PERSONNEL BOTH INDIVIDUALLY AND COLLECTIVELY, FROM ANY AND ALL LIABILITY FOR DAMAGE OF WHATEVER KIND, WHICH MAY RESULT AT ANY TIME RESULT TO ME, MY HEIRS, FAMILY AND ASSOCIATES RESULTING FROM THE AUTHORIZED RELEASE OF INFORMATION OR ATTEMPTED RELEASE OF SUCH INFORMATION, PURSUANT TO THE TERMS OF THIS RELEASE AND WAIVER.
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ABOVE IDENTITY VERIFIED BY OFFICER __________________________
VIA, NEW MEXICO I.D. CARD / DRIVERS LICENSE OR OTHER FORM OF PICTURE IDENTIFICATION
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WHEN COMPLETED, DROP OFF AT THE ROSWELL POLICE DEPARTMENT,
128 W. 2ND ST. ATTN: OFFICER JERRY LONOWSKI