Authorization For The Release Of Information Re A Firearm {PC-150}

CONNECTICUT PROBATE COURTS CONFIDENTIAL Instructions: 1) An adult person petitioning to restore his or her rights to purchase, possess or transport a firearm or ammunition may use this form to authorize the release of information to the Commissioner of Department of Emergency Services and Public Protection. 2)The original release shall be provided to the Department of Emergency Services and Public Protection. A copy of the release shall be filed in the probate district where the petitioner resides with the Petition to Restore Right to Purchase, Possess or Transport a Firearm or Ammunition, PC-100 3)For more information, see C.G.S. section 45a-100. 4)Type or print the form in ink. Probate Court Name District Number In the Matter of (Name, address, and telephone number) Social Security Number Signature Type or Print Name Date Date of Birth American LegalNet, Inc. www.FormsWorkFlow.com