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Receipt to Accompany release of library records pursuant to court order, court-sanctioned subpeona, or search warrant (sample)

I, _________________________, representing (individual or organization)______________________________________  at  (address)______________________________ request that the Library Director, acting on behalf of the Library Board of Directors, release the following specific information from library records as specified in the accompanying court-sanctioned document:

_________________________________________

_________________________________________

_________________________________________

_________________________________________


_______________________(signature) 

_______________________(date)      



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