Authorization to Release Criminal History
Record Information and Release of Liability
I, the undersigned, hereby authorize the ALEA Records and Identification Division (RID) to
release to my attorney,
(name) ______________________________________________________________________,
information which shall include but not be limited to, my entire criminal history record, any
information relative to my criminal history, and the details of my background check for the purpose of
future expungement request(s) pursuant to Alabama Code § 15-27-1 et seq. (1975). In addition, I
authorize the ALEA RID to discuss any information regarding procedures for updating or correction of
its records, as appropriate, as permitted by law and policy. This may include requests from the ALEA
RID to my attorney for information, clarification of information, and/or submission of additional
documentation on my behalf. NOTE: The reference to “my attorney” in this document includes not
only the individual lawyer named above but also any other attorney, paralegal, co-worker, or
employee with whom he or she presently is professionally associated and who adequately
establishes that association to the ALEA RID.
I further release ALEA and the ALEA RID from any and all liability of any kind for releasing any
and all information as described and agree to indemnify and hold ALEA and the ALEA RID harmless for
any damages or injury which might result directly or indirectly from the release of same.
The foregoing authorization shall continue in full force and effect until revoked by me in writing.
A photocopy of this authorization shall be considered the same as the original.
Full Name (First, Middle, Last, Suffix):
Applicant Current Address:
Zip Code:
Alias or Nickname(s): Sex/Gender:
Social Security Number: Date of Birth: (month/date/year)
Black Asian Indian Other (please specify)
Current Driver’s License Number: Issuing State:
Applicant Signature Date
Sworn to and subscribed before me this __________ day of ______________________________, 20__________.
Notary Signature_________________________________ My Commission Expires ___________________, 20___.