Information to be disclosed to:
Or received from:
City of Schertz Police Department_________________________________________________
1400 Schertz Parkway, Schertz, Texas 78154________________________________________
Address: Street City State Zip
(210) 619-1200________________ (210) 619-1220____________
I understand that I may revoke this authorization at any time by requesting such of the above referenced company in writing, unless action has already been taken in reliance upon it.