Congressman Donald Norcross

Representing the 1st District of New Jersey
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Pursuant to the Privacy Act of 1974 (5 U.S.C. § 552a) I hereby authorize appropriate agencies to release information about me, and relevant to this inquiry to the Office of the First Congressional District of New Jersey. I hereby authorize Congressman Donald Norcross of the United States House of Representatives to forward to the appropriate agency any medical records pertaining to me that I have provided to his office relevant to this inquiry.


Authorization Form

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In accordance with the Privacy Act of 1974, I give Congressman Donald Norcross authority to act on my behalf.

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