The Authorization to Release Form is a document of the DC Department of Licensing and Consumer Protection (DLCP), Occupational and Professional Licensing Division, issued together with the Metropolitan Police Department (MPD) Security Officers Management Branch. If you reached this page while researching a DC business license, note that this form is narrower: it is the release an applicant signs so that MPD can obtain information from their records. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the original PDF is published by DLCP at dlcp.dc.gov.
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What is Authorization to Release Form – Washington, DC?
The Authorization to Release Form (printed title: Authorization to Release Information) is a sworn statement in which an applicant for a DC Department of Licensing and Consumer Protection (DLCP) license authorizes the Metropolitan Police Department (MPD) to obtain information from the applicant's records.
The form is a one-page release with a notary block. The applicant writes their name and the position they are applying for, certifies that they are applying for a license with DLCP in the District of Columbia, and then signs, dates and gives an address. The heading names the DLCP Occupational and Professional Licensing Division and the MPD Security Officers Management Branch.
By signing, the applicant authorizes the release to MPD of any information it requests, from whomever it considers necessary, from any of the applicant's records or files. The form lists examples, including hospital, medical, military, police, arrest, court, credit, employment, attendance, traffic, confidential and educational records, police reports (including juvenile records), police polygraphs, examination reports, background investigative material and department transcripts. The list is not limited to those items. The applicant also releases all persons from liability for furnishing the information to MPD.
Two more terms apply. MPD may copy the document and treat the copies as the original, while the original stays on file with MPD. And if the application is disapproved, the sources of confidential information cannot be revealed to the applicant.
Who needs to file Authorization to Release Form – Washington, DC?
The form is written for a person who is an applicant for a position and is applying for a license with the DC Department of Licensing and Consumer Protection (DLCP). That applicant signs it to permit the Metropolitan Police Department (MPD) to request information from their records.
Points the form itself makes clear:
- The applicant completes their own name, the position applied for, their signature, date and address.
- The signature is sworn: the form ends with a block that reads "Subscribed and sworn to before me, a Notary Public," so a notary completes the date, seal, signature and commission expiration.
- The applicant accepts the terms described on the form, including the release of juvenile records and the release of all persons from liability for furnishing information to MPD.
The form does not describe who may sign for someone else, and it names no exemptions. If you are unsure whether your license application calls for this release, ask DLCP at its Helpline, (202) 671-4500, or at dlcp.dc.gov.
When to file Authorization to Release Form – Washington, DC
The form prints no due date of its own. It is written for a person who is applying for a license with the DC Department of Licensing and Consumer Protection (DLCP), so it belongs with that application and is signed when the applicant is ready to authorize the Metropolitan Police Department (MPD) to request their records.
The notary block asks for the day, month and year (20__) on which the document is sworn, so complete it on the date you appear before the notary. For questions about timing within your application, DLCP lists a Helpline at (202) 671-4500 and the website dlcp.dc.gov.
How to fill out Authorization to Release Form – Washington, DC
Read the authorization terms
Read the release before entering anything. It authorizes the Metropolitan Police Department to obtain information from your records, releases all persons from liability for furnishing it, and lets MPD copy the document.
Enter your name
In the opening certification, write your name on the line marked (Name).
Enter the position applied for
Write the position you are applying for on the line after "for the position of".
Sign and date the form
Sign on the Signature line and enter the date on the Date line. The form is sworn, so sign according to the notary's instructions.
Enter your address
On the line below the signature, write your address, city, state (ST) and ZIP code.
Have the notary complete the block
The notary fills in the day, month and year, affixes the seal, signs as Notary Public and enters the commission expiration date.
Review and download the completed PDF
Check that your name, position, signature, date, address and the notary block are complete. Download or print the completed PDF from FillingPDF and return it as DLCP directs.
How to submit Authorization to Release Form – Washington, DC
The form names no mailing address, portal or office for returning it. It says the original document is to be retained on file with the Metropolitan Police Department (MPD), and that MPD may make copies that act as the original.
- Contact DLCP: ask the DC Department of Licensing and Consumer Protection how to return the signed and notarized form with your license application. The form lists the DLCP Helpline at (202) 671-4500 and the website dlcp.dc.gov.
- Before you send it: make sure the applicant's signature, date and address are complete and that the notary has filled in the day, month, year, seal, signature and commission expiration.
FillingPDF lets you fill out and download the PDF; submission follows the agency's channels.
Common mistakes to avoid
- Leaving the notary block blank: the form requires the day, month, year, seal, notary signature and commission expiration under the sworn statement.
- Omitting the name or the position applied for in the opening certification.
- Submitting the form unsigned, or without the date and the address line beneath the signature.
- Assuming the release is limited to the records listed: the form states the list is not limited to those items.
- Expecting to learn the sources of confidential information if the application is disapproved; the form says they cannot be revealed.
- Treating this release as the license application itself; it only authorizes records to be released to the Metropolitan Police Department.
Frequently asked questions
What is the Authorization to Release Form?
It is a DLCP release, titled Authorization to Release Information on the form, that a license applicant signs so the Metropolitan Police Department can request information from their records. The form also releases all persons from liability for furnishing that information to MPD.
Does the Authorization to Release Form have to be notarized?
The form includes a notary block that begins "Subscribed and sworn to before me, a Notary Public." It asks for the day, month and year, the seal, the notary's signature and the commission expiration date, so plan to have it completed before a notary.
What records does the release cover?
It covers any information MPD requests from your records, including hospital, medical, military, police, arrest, court, credit, employment, traffic and educational records, and police reports including juvenile records. The form states the list is not limited to those items.
Will I see who provided confidential information if my application is denied?
No. The form states that if the application is disapproved, the sources of confidential information cannot be revealed to the applicant. You acknowledge this by signing the release.
Where do I send the signed Authorization to Release Form?
The form prints no address or portal. It says the original is retained on file with the Metropolitan Police Department. Ask DLCP how to return it with your application: the Helpline is (202) 671-4500 and the website is dlcp.dc.gov.
Can I fill out the Authorization to Release Form online?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service and does not file or send the form; the signed, notarized form is returned through DLCP's channels.
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