85 East 7th Place, Suite 125, St. Paul, MN 55101-2143
Ph: 651-296-7938 • Fax: 651-282-2644 • boa.state.mn.us
CLEAR
CLEAR
FORM
FORM
AUTHORIZATION TO RELEASE
APPLICANT INFORMATION
TO A THIRD PARTY
THIS FORM IS NOT REQUIRED
Only complete this optional form if you intend someone other than yourself to
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 to Release Information Form—Page 1 of 1
Rev 03/18
85 East 7th Place, Suite 125, St. Paul, MN 55101-2143
Ph: 651-296-7938 • Fax: 651-282-2644 • boa.state.mn.us
CLEAR
CLEAR
FORM
FORM
AUTHORIZATION TO RELEASE
APPLICANT INFORMATION
TO A THIRD PARTY
THIS FORM IS NOT REQUIRED
Only complete this optional form if you intend someone other than yourself to
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 to Release Information Form—Page 1 of 1
Rev 03/18
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