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IN THE DISTRICT COURT OF STATE OF OKLAHOMA Waiver of Privacy Act and Freedom of Information Act Protections Relating to Passport Applications

COUNTY

The undersigned applicant for a United States Passport, acknowledges that he/she has been advised by the Clerk of the above captioned court that the Privacy Act of 1974 and the Freedom of Information Act prohibit the release and disclosure of the identity of persons who have applied for or been issued United States Passports.

Therefore, the applicant does hereby voluntarily and intentionally waive the applicant's statutory rights of the Privacy Act of 1974, and authorizes the Clerk of the Court to write a receipt for the execution fee and place applicant's name on transmittal letter to be forwarded to Passport Agency.

Applicant

Subscribed and sworn to before me this

day of

, 20

.

Court Clerk

Deputy Court Clerk

AOC Form 43b
Revised 8/05