"Authorization to Release Applicant Information to a Third Party" - Minnesota

Authorization to Release Applicant Information to a Third Party is a legal document that was released by the Minnesota Board of Accountancy - a government authority operating within Minnesota.

Form Details:

  • Released on June 1, 2018;
  • The latest edition currently provided by the Minnesota Board of Accountancy;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Minnesota Board of Accountancy.

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85 East 7th Place, Suite 125, St. Paul, MN 55101-2143
Ph: 651-296-7938 • Fax: 651-282-2644 • boa.state.mn.us
AUTHORIZATION TO RELEASE
APPLICANT INFORMATION
TO A THIRD PARTY
THIS FORM IS NOT REQUIRED
CLEAR
CLEAR
Only complete this optional form if you intend someone other than yourself to
FORM
FORM
contact the Board regarding the status of your application.
Minnesota law prohibits the Board from sharing any information regarding
your application (prior to final licensure) with
anyone
other than yourself
unless you submit this authorization.
AUTHORIZATION/RELEASE
Applicant data is classified as private or confidential under the Minnesota Data Practices
Act. However,
I hereby waive my rights under the Minnesota Data Practice Act
and
authorize the Minnesota Board of Accountancy to provide information contained in my
application materials, including any documents, to the following individual:
Provide first and last name of third party who may receive information.
I understand that I am not legally required to sign this form. The purpose of this
authorization is to facilitate the processing of my application. This authorization
automatically expires one year after this date.
Printed Name of Applicant
Date
Applicant Signature
Authorization for Release of Information Form—Page 1 of 1
Rev 06/18
85 East 7th Place, Suite 125, St. Paul, MN 55101-2143
Ph: 651-296-7938 • Fax: 651-282-2644 • boa.state.mn.us
AUTHORIZATION TO RELEASE
APPLICANT INFORMATION
TO A THIRD PARTY
THIS FORM IS NOT REQUIRED
CLEAR
CLEAR
Only complete this optional form if you intend someone other than yourself to
FORM
FORM
contact the Board regarding the status of your application.
Minnesota law prohibits the Board from sharing any information regarding
your application (prior to final licensure) with
anyone
other than yourself
unless you submit this authorization.
AUTHORIZATION/RELEASE
Applicant data is classified as private or confidential under the Minnesota Data Practices
Act. However,
I hereby waive my rights under the Minnesota Data Practice Act
and
authorize the Minnesota Board of Accountancy to provide information contained in my
application materials, including any documents, to the following individual:
Provide first and last name of third party who may receive information.
I understand that I am not legally required to sign this form. The purpose of this
authorization is to facilitate the processing of my application. This authorization
automatically expires one year after this date.
Printed Name of Applicant
Date
Applicant Signature
Authorization for Release of Information Form—Page 1 of 1
Rev 06/18