HUMBOLDT COUNTY TRIAL COURT RULES Appendix 9.4 CONSENT TO RELEASE OF INFORMATION To Whom it May Concern: This is to inform you that at no expense to the undersigned, you are authorized to release to my spouse or to my spouse's attorney of record upon request, information which you may possess and which they might deem material as to the matters hereof specified ( ) Wage records ( ) Records relating sharing benefits ( ) Records relating to insurance policies ( ) Records relating to health care benefits to retirement pension, or profit This authorization is intended to extend to the right to observe, make excerpts from or make photocopies of, at their discretion, any records to which I would be entitled which otherwise would be considered confidential. This authorization shall apply for a time period of one year from the date appearing hereon unless sooner revoked by my written notice to you to that effect. Dated: Signature I am the spouse of immediately above. I am: ( ) person whose signature appears Representing myself ( ) the Represented by: Please send the records designated above to the following address: Dated: Signature (36) 2000 (C) American LegalNet, Inc.