FOR ABI USE ONLY CRIMINAL HISTORY INFORMATION RELEASE FORM ABI-46 (Revised 9/13/05) MAIL THIS RELEASE FORM AND FINGERPRINT CARDS TO: ABI – Identification Unit P. O. Box 1511 Montgomery, Alabama 36102-1511 SECTION 1. Type or print legibly Last Name* (*) Required Information First Name* Middle Name* All other names used* Address / City / / MM* DD* YYYY* / Social Security Number* State Race* Zip Code Sex* SECTION 1.A. AFFIDAVIT FOR RELEASE OF INFORMATION I do hereby for myself, my heirs, executors, and administrators release and forever discharge the Alabama Department of Public Safety/ABI, Department of Conservation and Natural Resources and their officers and agents from any and all claims, actions, or causes of action, which may arise as a consequence of the release of the criminal history information. I certify that I have read this release and that I understand the significance of the same and in witness thereof I have voluntarily day of 20 . signed my name on this the Signature of Applicant * Name of Witness (1) Name of Witness (2) Address of Witness Address of Witness City State Zip Code Sworn to and subscribed before me on this City State Zip Code day of My Commission Expires , 20 . , 20 Signature of Notary Public SECTION 2. (To be completed by CHILDREN’S TRUST FUND) I am possessed of sound mind and legally competent to execute this release. I hereby authorize the Alabama Department of Public Safety/ABI to release any and all criminal history information to, Children’s Trust Fund PO BOX 4251 Montgomery, AL 36103 (Social Security Number on File) Signature & Social Security Number of Applicant or Person to receive results Date American LegalNet, Inc. www.FormsWorkflow.com