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CONSENT/RELEASE OF INFORMATION AUTHORIZATION FORM FOR THE PENNSYLVANIA CHILD ABUSE HISTORY CLEARANCE I, (Applicants Name), hereby authorize the Department of Public Welfare, Childlike to release my
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Begin by writing the applicant's legal full name in the designated field. Include their first name, middle name (if applicable), and last name. Avoid using any nicknames or abbreviations.
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Make sure the name is spelled correctly and matches any official documents or identification the applicant may have.
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