Parent Coordinator Application Form Page 8
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8Mail: Family Court Services
Lawson E. Thomas Courthouse Center
st
175 NW 1
Avenue Suite 1503
Miami, FL 33128
Fax:
Family Court Services
Attn: Parenting Coordination Program
305-349-5634
AUTHORIZATION TO INVESTIGATE AND RELEASE OF INFORMATION
I,
of
(name)
(address)
authorize the above named court to conduct a criminal history and background investigation on
me. I authorize the release of information and/or documents to this court from the Florida
Department of Children and Families; the Florida Department of Law Enforcement; any city,
county, state and/or federal law enforcement agencies; any school; and any other entity. I release
this court from any and all liability and expense associated with this investigation or release of
information and/or documents.
Signature
Date
STATE OF FLORIDA
COUNTY OF
Sworn to or affirmed and signed before me by
on
.
NOTARY PUBLIC or DEPUTY CLERK
[Print, type, or stamp name of notary or clerk.]
Personally known
Produced identification
Type of identification produced
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