1. (a) The following shall be provided by the person authorizing release of his or her criminal conviction record:

   1. (1) Name, including any alias, and address;
   2. (2) Date of birth;
   3. (3) Driver license number and state, if licensed;
   4. (4) Eye, hair color, and sex;
   5. (5) Use for the record;
   6. (6) Name of person or agency authorized to receive record;
   7. (7) Address of person or agency authorized to receive record;
   8. (8) Signature and date signed by person authorizing release of his or her criminal conviction record; and
   9. (9) Signature and seal of a notary public or signature of a justice of the peace and date.

2. (b) The requestor shall provide the following:

   1. (1) Signature and printed name of requestor or person acting on behalf of agency; and
   2. (2) Date.

Source. (See Revision Note at Chapter Heading for Saf-C 5700) #6704, eff 3-3-98; amd by #8173, eff 9-21-04; amd by #8591, INTERIM, eff 3-24-06, EXPIRES: 9-20-06; ss by #8651, eff 6-2-06, EXPIRED: 6-2-14 New. #11157, INTERIM, eff 8-18-16, EXPIRED: 2-14-17 New. #12132, eff 3-17-17