ROSWELL POLICE DEPARTMENT MALL SUBSTATION
VOLUNTEER RELEASE AND WAIVER
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VOLUNTEER NAME
I HEREBY AUTHORIZE ANY POLICE OFFICER OR OTHER REPRESENTATIVE OF THE
ROSWELL POLICE DEPARTMENT BEARING THIS RELEASE OR A COPY THEREOF, WITHIN ONE YEAR OF THE
DATE INDICATED BELOW, TO OBTAIN INFORMATION CONTAINED IN ANY FILE, COMPUTER BANK, OR OTHER
COMPILATION SYSTEM RELATING TO CRIMINAL HISTORY INFORMATION MATTERS. THIS WAIVER EXTENDS
TO ANY AND ALL INFORMATION PROCESSED BY LOCAL, STATE OR FEDERAL LAW ENFORCEMENT AGENCY
WHICH RETAINS CRIMINAL HISTORY INFORMATION.
I HEREBY DIRECT YOU TO RELEASE THIS INFORMATION UPON REQUEST OF THE
BEARER. THIS RELEASE IS EXECUTED WITH FULL KNOWLEDGE AND UNDERSTANDING THAT THE
INFORMATION IS FOR THE OFFICIAL USE OF THE ROSWELL POLICE DEPARTMENT.
CONSENT IS GRANTED FOR THE ROSWELL POLICE DEPARTMENT TO FURNISH THE
INFORMATION DESCRIBED ABOVE TO THIRD PARTIES IN THE COURSE OF FULFILLING ITS OFFICIAL
RESPONSIBILITIES.
I HEREBY RELEASE YOU, AS THE CUSTODIAN OF SUCH RECORDS, AND AN SCHOOL,
COLLEGE, UNIVERSITY OR OTHER EDUCATIONAL INSTITUTION, FORMER EMPLOYER OF ANY CAPACITY, LAW
ENFORCEMENT AGENCY, INCLUDING ITS OFFICERS, EMPLOYEES, OR RELATED PERSONNEL BOTH
INDIVIDUALLY AND COLLECTIVELY, FROM ANY AND ALL LIABILITY FOR DAMAGE OF WHATEVER KIND,
WHICH MAY RESULT AT ANY TIME RESULT TO ME, MY HEIRS, FAMILY AND ASSOCIATES RESULTING FROM
THE AUTHORIZED RELEASE OF INFORMATION OR ATTEMPTED RELEASE OF SUCH INFORMATION, PURSUANT
TO THE TERMS OF THIS RELEASE AND WAIVER.
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SIGNATURE OF APPLICANT |
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DATE |
ABOVE IDENTITY VERIFIED BY OFFICER __________________________
VIA, NEW MEXICO I.D. CARD / DRIVERS LICENSE OR OTHER FORM OF PICTURE IDENTIFICATION
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WHEN COMPLETED, DROP OFF AT THE ROSWELL POLICE DEPARTMENT,
128 W. 2ND ST. ATTN: OFFICER JERRY LONOWSKI
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