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DC4 711B Consent for Authorization for Use and Disclosure Inspection and Release of Confidential Information Revised 1314 2016
As to the records and information denoted in paragraphs A B C D and E by initialing the appropriate box es above. FLORIDA DEPARTMENT OF CORRECTIONS CONSENT AND AUTHORIZATION FOR USE AND DISCLOSURE INSPECTION AND RELEASE OF CONFIDENTIAL INFORMATION I authorize Name organization or general designation of program making disclosure to disclose to Name of person s or organization s and address to which disclosure is to be made Purpose of disclosure authorized herein The undersigned hereby authorizes...
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