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ICE Privacy Release Form

PRIVACY WAIVER AUTHORIZING DISCLOSURE TO A THIRD PARTY

If you are a resident of the Fifth District and have been impacted by the operations of ICE and Border Patrol agents in Minnesota, please contact my office at (612) 333-1272 for assistance.

Use this form to authorize the U.S. Department of Homeland Security (“DHS”) to disclose information and/or records about you to a third party. Taking this action is entirely voluntary; you are under no obligation to consent to the release of your information to any third party. Authority: Privacy Act of 1974 (5 U.S.C. § 552a); DHS Privacy Act Regulations (6 C.F.R. § 5.21(d)).

ICE Privacy Release Form

Issues:Immigration