AUTHORIZATION TO RELEASE INFORMATION

I, ________________________, hereby authorize _______________________________

To access copies of my records, obtain information and records regarding my case,
and discuss my case with the Oakland Police Department.
This authorization covers any and all aspects of my case.
This authorization expires 1 year from the date of execution as indicated below.
I READ THIS AUTHORIZATION PRIOR TO SIGNING.

_____________________________________
PRINTED NAME:
DATE OF BIRTH:

DATE: ______________________________