ࡱ> ac` @ Z3bjbj{{ X9H}@@@@PPP8,)\( B!,-!V)X)X)X)X)X)X)$*RK-|)9$a ^ $$|)@@[)%%%$(@RV)%$V)%%"%P P%(%r&)0)%-<%v-%@@@@-%E!"%"t#E!E!E!|)|)D D %   STATE OF SOUTH CAROLINA DEPARTMENT OF CONSUMER AFFAIRS PRENEED FUNERAL CONTRACTS  HYPERLINK "http://www.scstatehouse.net/code/t32c007.htm" S.C. Code Ann. 32-7-10 et seq.  HYPERLINK "http://www.scconsumer.gov" www.scconsumer.gov 803-734-4236/800-922-1594 AUTHORIZATION TO RELEASE INFORMATIONI,  FORMTEXT      do hereby authorize the release of financial and criminal background information to the South Carolina Department of Consumer Affairs and its agents. I understand that any personal information will be used in regard to the application for a license to sell preneed funeral contracts.I also understand that this authorization releases the South Carolina Department of Consumer Affairs from any legal action. Signature of Applicant FORMTEXT      Date of Birth;WXūņmTm9mT4h$h 0J5B*CJOJQJaJmHphsH0h$h 5B*CJOJQJaJmHphsH1jhhh 5B*CJOJQJUaJphh B*CJOJQJaJph(jhH^:hgCJUaJmHnHu3jhg5>*CJOJQJU\aJmHnHuhh CJOJQJaJh~bh CJOJQJaJ0jh~bh CJOJQJUaJmHnHuhvW   6 7 8 Dkd$$IfTl2%% t644 laT $$Ifa$gd{hgd %d &d O P gd gd\V 1^2X3   5 A E F dznjwb[WOJ?0jh"0h}fCJUaJh"0hl%CJaJ h 5h\Vh 5h  htS h )h 0J56:;CJOJQJ\aJ)hzh 0J56CJOJQJ\aJ hzh 0JCJOJQJaJ+jhzh CJOJQJUaJ&hzh 0J6CJOJQJ]aJ/jhzh 0J6CJOJQJU]aJ@h$h 0J56:;B*CJOJQJ\aJmHphsH8 9 : ; < iDkd$$IfTl2%% t644 laT $$Ifa$gd{hDkdi$$IfTl2%% t644 laT< = > ? @ iDkd$$IfTl2%% t644 laT $$Ifa$gd{hDkdi$$IfTl2%% t644 laT@ A E  L Dlkd]$$IfTlF2%V3 t6    44 laT $Ifgd"0Dkdi$$IfTl2%% t644 laTF P Q  L N P R N P R T V X Z \ ^ ` b d h j Է~l†#j h2h2CJUaJh2CJaJjh2CJUaJhl%h CJ aJ h 5h CJaJ hl%5hl%CJaJh"0hl%CJaJ"jhX CJUaJmHnHujh"0h}fCJUaJ#jh"0h2CJUaJh"0h}fCJaJ*L N P R N ja $Ifgd"0Dkd$$IfTl2%% t644 laT $Ifgd{hFkd!$$IfTl2%% t644 laTN P R T V lDkd$$IfTl2%% t644 laT $Ifgd{hDkd+$$IfTl2%% t644 laTV X Z \ ^ lDkd$$IfTl2%% t644 laT $Ifgd{hDkd1$$IfTl2%% t644 laT^ ` b d f h lDkd$$IfTl2%% t644 laT $Ifgd{hDkd1$$IfTl2%% t644 laTh j :Wkd $$IfTl0F2% t644 laT $Ifgd{h $$Ifa$gdl%Wkd1 $$IfTl0F2% t644 laT F: $$Ifa$gdl%Wkd $$IfTl0F2% t644 laT $Ifgd{hWkdy $$IfTl0F2% t644 laT :Wkd $$IfTl0F2% t644 laT $Ifgd{h $$Ifa$gdl%Wkd $$IfTl0F2% t644 laT 00000 0"0&0(0<0>0@0D0F0L0N0b0d0f0n0p0t0v0000000履weZhl%h CJ aJ #juhhD+CJUaJhCJaJjhCJUaJ#jh}fh2CJUaJh}fCJaJjh}fCJUaJhl%CJaJ"jhX CJUaJmHnHu#jh2h2CJUaJh2CJaJjh2CJUaJU h 5h CJaJ# r0t0F: $$Ifa$gdl%Wkd $$IfTl0F2% t644 laT $Ifgd{hWkda $$IfTl0F2% t644 laT FORMTEXT    -  FORMTEXT    -  FORMTEXT     Applicant s Social Security NumberSWORN TO AND SUBSCRIBED before methis _____ day of _____________, 20___Notary PublicMy Commission Expires: Authorization Release Revised 08/06 Page  PAGE 1 of  NUMPAGES 1 Street Address 3600 Forest Drive, 3rd Floor Columbia, SC 29204-4406 Mailing Address P.O. 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