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(last, middle, first)
My relationship to the above-named juvenile who is the subject of the records requested
I hereby authorize the custodian of Lake Delton Police Department Juvenile Records to release the juvenile report involving the above-specified juvenile, subject to departmental policy and approval. This authorization is applicable solely for the release of the above-specified juvenile record. By signing this authorization, I am confirming that it accurately reflects my wishes.
Please upload the juvenile's birth certificate, listing you as his/her parent, or other documentation showing you are a legal custodian or guardian for the juvenile or are otherwise legally entitled to receive these records
This field is not part of the form submission.
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