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DHS/DSP 8/15-Page 1 of 1 Form 12 DIVISION OF SERVICES FOR PEOPLE WITH DISABILITIES AUTHORIZATION TO FURNISH INFORMATION AND RELEASE FROM LIABILITY Name: DOB: I am: Theindividualnamedabove Theindividualslegallyauthorizedpersonalrepresentative
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The state of Utah Department refers to the government agency in Utah responsible for overseeing various state programs and services.
Certain businesses, individuals, and organizations in Utah may be required to file with the state of Utah Department based on their activities.
To fill out the state of Utah Department forms, individuals or entities must provide accurate information as requested and follow the guidelines provided by the department.
The purpose of the state of Utah Department is to regulate and administer various programs and services in the state to ensure compliance with state laws and regulations.
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