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Minnesota Criminal Records Check Release Form

If the police department wants to notify the court overseeing your case that you have a clean criminal record in the State of Minnesota, the Minnesota Criminal Records Check Release Form has to be used.

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Extracted Text for Proper Search

Criminal History Check Release 	
 	
 
Full Name             
List Any Other Names By Which You Have Been Known	: 	 	
    First   Middle   Last 	
 
_________________________________________________________________________________ 
 
_________________________________________________________________________________ 
 
   
Date of Birth     	†	 Female  	†	 Male  	Race    	 	
 
I hereby give permission to law enforcement ag encies, the Bureau of Criminal Apprehension 
and/or the Federal Bureau of Investigation to release criminal history information to the court. 
 
 
Your Signature           	 	
 	
If incomplete, we will not be able to process your application. 	
Record information will be placed in the name change file that is accessible to the public. 	
NAM103 State  ENG  Rev 9/07    www.mncourts.gov/forms Page 1 of 1
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