Authorization For The Release Of Information Re Application To Restore Right To Purchase Posses Or Transport A Firearm
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Authorization For The Release Of Information Re Application To Restore Right To Purchase Posses Or Transport A Firearm Form. This is a Connecticut form and can be use in Probate Statewide.
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Tags: Authorization For The Release Of Information Re Application To Restore Right To Purchase Posses Or Transport A Firearm, PC-150, Connecticut Statewide, Probate
AUTHORIZATION FOR THE
RELEASE OF INFORMATION
RE APPLICATION TO RESTORE
RIGHT TO PURCHASE, POSSESS OR
TRANSPORT A FIREARM, P.A. 11-134
PC-150
STATE OF CONNECTICUT
COURT OF PROBATE
RECORDED (CONFIDENTIAL VOLUME):
NEW 7/11
TO: COURT OF PROBATE,
DISTRICT NO.
IN RE [Petitioner’s Name, address, date of birth, social security number and telephone number]
I, the undersigned person or legal representative, hereby authorize the release of the following records related to
my application for restoration of my right to purchase, possess or transport a firearm under P.A. 11-134 to the Commissioner
of Public Safety:
health records
mental health records
military records
immigration records
Probate Court records
Juvenile Court records
Civil Court records
Criminal Court records
other [specify]
I authorize the Commissioner of Public Safety to obtain any of the records listed above for use at a Probate Court hearing or
in any appeal from the decision of the Probate Court.
DATE
Petitioner’s Signature
AUTHORIZATION FOR THE RELEASE OF INFORMATION
RE APPLICATION TO RESTORE RIGHT TO PURCHASE, POSSESS OR
TRANSPORT A FIREARM, P.A. 11-134
PC-150 NEW 7/11
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