CONSENT FOR RELEASE OF PERSONAL RECORD INFORMATION
The Privacy Act of 1974 generally prohibits applicable Government agencies from revealing particular information from personal files of individuals without the express consent of the person involved. Disclosure of personal records to a Representative who is acting on behalf of a constituent may be prohibited unless the individual to whom the record pertains has consented.
I, the undersigned, hereby authorize Representative Jeramey Anderson and/or his staff to receive information in my file in connection with his and/or his staff's inquiry on my behalf.
*PLEASE BE ADVISED THAT A PHYSICAL COPY OF THIS CONSENT WITH YOUR SIGNATURE MUST BE ON FILE IN ORDER TO COMPLETE YOUR REQUEST*