House of Reps

Office of Representative
Alcee Hastings

Digital Privacy Release Form

Constituent Authorization

Under the Federal Privacy Act of 1974, we must have a signed privacy release form that clearly outlines your problem and the remedy you are seeking. This digital form provides our office permission to look into the matter on your behalf. Please make sure to attach below any relevant identifying information and supporting documents which relate to your inquiry.

I hereby request the assistance of the Office of Alcee Hastings to resolve the matter described below. I authorize Alcee Hastings to receive any information that they might need to provide this assistance. The information I have provided to Alcee Hastings is true and accurate to the best of my knowledge and belief. The assistance I have requested from Rep. Alcee Hastings is in no way an attempt to evade or violate any federal, state, or local law.

Please Provide Applicable Identifying Information


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