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Privacy Release Form

(en español)

The PRIVACY ACT OF 1974 requires that written consent be obtained from a constituent before information can be disclosed from records with a federal agency. In order for Congressman Meek to conduct an inquiry on your behalf, he would appreciate your completing, printing, and signing the following statement. (If you are inquiring on behalf of someone else, the authorization must be signed by the person whose case is in question.)

      

   

    Florida    

        

The following personal information will help our staff track your claim.

        

        

 

        


In accordance with the Privacy Act of 1974 (5 USC 552), I hereby authorize Representative Kendrick Meek and his designated staff to seek disclosure of all records relevant to my case from the federal agency involved.

Signature:

Date:

  

The print preview button will take you to a page that you can print, sign, and mail.