The information release form is the authorization, printed as Authorization to Release Information (V2 5/2023), that lets Montana's Cannabis Control Division (CCD) share information about your account with a third party you name. The Montana Department of Revenue publishes it. You use it when someone else, such as a family member, an agent or a bank, needs information from your CCD account. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the official PDF is published at the Montana Department of Revenue website.
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What is Information Release Form – Montana?
The Information Release Form, printed on the PDF as Authorization to Release Information, is the document on which an individual authorizes Montana's Cannabis Control Division (CCD) to release information about their account to a named third party. The Montana Department of Revenue publishes it.
The form identifies the person receiving the information (name, relationship to you, address, email address and fax number) and how CCD may send it: mail, email, fax or phone conversation, with a box for each. You then mark what the release covers:
- sharing medical card account information;
- medical history for power of attorney;
- sharing license account information;
- license account information for banks, where the standard information shared is good standing, ownership information and license/sites;
- other, described in the space provided.
The authorization expires one year from the date signed unless you specify another date. The form also states that you can submit a written request to revoke your consent at any time.
The form is limited to releasing information. Its own text says it is not to be used to add a manager, controlling beneficial owner, financial interest holder, power of attorney, or other affiliate that controls, manages, represents or makes decisions on behalf of the business.
Who needs to file Information Release Form – Montana?
Individuals who have an account with Montana's Cannabis Control Division (CCD) and want CCD to release information about that account to someone else use this form. The person completing it enters their own name, signs it and gives their contact details.
The form is built for situations such as:
- sharing medical card account information with a person you name;
- sharing medical history for power of attorney;
- sharing license account information with a person you name;
- giving a bank the license account information described on the form (good standing, ownership information, license/sites);
- any other release you describe in the "other" space.
Do not use this form to add a manager, controlling beneficial owner, financial interest holder, power of attorney, or other affiliate that controls, manages, represents or makes decisions on behalf of the business. The form says it only authorizes CCD to release information to a third party. The form prints no rule about who may sign for someone else, so contact CCD if another person will complete it for you.
When to file Information Release Form – Montana
Submit the form when you want CCD to start releasing account information to a third party. The form sets no filing deadline of its own.
The authorization expires one year from the date you sign it, unless you enter another date in the expiration space on the form. If the third party still needs information after that date, you need a new authorization.
You can end the authorization sooner: the form states that you may submit a written request to revoke your consent at any time.
How to fill out Information Release Form – Montana
Enter your name in the statement
In the opening sentence, "I, ___ hereby authorize Montana's Cannabis Control Division," type the name of the individual completing the form.
Identify who receives the information
Fill in Name, Relationship to me, Address, Email Address and Fax Number for the third party who will receive your account information.
Check how information may be sent
Under "Information should be sent via (check all that apply)," check Mail, Email, Fax and/or Phone Conversation.
Select what the release covers
Check the option that applies: sharing medical card account information, medical history for power of attorney, sharing license account information, license account information for banks, or Other.
Describe other or clarifying details
If you checked Other, or want to clarify the request, describe it in detail in the space under "If other, or for clarification of request."
Set an expiration date if needed
The authorization expires one year from the date signed. Enter a different date in the expiration space only if you want another date to apply.
Sign and date the authorization
Sign and enter the date next to the statement that you can submit a written request to revoke consent at any time.
Add your printed name and contact details
Enter your Printed Name, Phone Number, Street Address, City, State and ZIP Code.
Review and download the completed PDF
Check the recipient details, the boxes you marked and the signature, then download or print the completed PDF from FillingPDF and email it as described under How to submit.
How to submit Information Release Form – Montana
The form names one channel: email.
- Email: send the completed form to [email protected].
The form prints no mailing address, portal or fax number for returning it; the mail, email, fax and phone options on the form describe how CCD may send information to your third party, not how you return the form. FillingPDF lets you fill out and download the PDF; submission follows the channel above.
Common mistakes to avoid
- Using the form to add a manager, controlling beneficial owner, financial interest holder, power of attorney or other affiliate; it only authorizes release of information to a third party.
- Leaving the recipient's details incomplete when the form asks for a name, relationship to you, address, email address and fax number.
- Not checking at least one delivery method (mail, email, fax or phone conversation) for the information.
- Choosing "Other" without describing the request in the space for details, or skipping the description when you need clarification.
- Assuming the authorization lasts indefinitely; it expires one year from the date signed unless another date is specified.
- Sending the form unsigned or undated; the signature and date lines are part of the authorization.
- Trying to revoke the authorization informally; the form says to submit a written request to revoke consent.
- Mailing or faxing the form when it directs you to email the completed form to [email protected].
Frequently asked questions
What is the information release form for?
It authorizes Montana's Cannabis Control Division (CCD) to release information about your account to a third party you name. You choose what the release covers, such as medical card account information, license account information or an other request you describe.
Where do I send the completed information release form?
Email the completed form to [email protected]. That is the only return channel printed on the form. The mail, email, fax and phone options on the form describe how CCD may send information to your third party.
How long is the authorization valid?
One year from the date you sign it, unless you specify another date on the form. After it expires, CCD has no authorization from you to continue releasing information, so complete a new form if the third party still needs it.
Can I cancel the authorization before it expires?
Yes. The form states that you can submit a written request to revoke your consent at any time. Put the request in writing rather than relying on a phone conversation, since the form specifies a written request.
Can I use this form to add a power of attorney or manager to my business?
No. The form says it is not to be used to add a manager, controlling beneficial owner, financial interest holder, power of attorney or other affiliate that controls, manages, represents or makes decisions for the business. It only releases information.
What information can CCD share with my bank?
If you check the license account information for banks option, the form lists the standard information shared: good standing, ownership information and license/sites. For anything beyond that, use the Other option and describe it.
Can I fill out the information 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 send the form to CCD; you email the completed form to [email protected] yourself.
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