Blank Condominium Association, Inc.

c/o Basulto Robbins & Associates, LLP

14160 NW 77th Court, Suite 22

Miami Lakes, Florida 33016

Broward (954) 510-1000 Miami-Dade (305) 722-8900

Authorization for Release of Information

On July 1, 2010, §718.112(12), Florida Statutes was amended to provide that newly elected board members take a division approved educational curriculum once elected to qualify for board service. Specifically §718.112(12)(c)(5), Florida Statutes, states:

“e-mail addresses, telephone numbers, facsimile numbers, emergency contact information, addresses of a unit owner other than as provided to fulfill the association’s notice requirements, and other personal identifying information of any person, excluding the person’s name, unit designation, mailing address, property address, and any address, e-mail address, or facsimile number provided to the association to fulfill the association’s notice requirements. However, an owner may consent in writing to the disclosure of protected information described in this subparagraph. The association is not liable for the inadvertent disclosure of information that is protected under this subparagraph if the information is included in an official record of the association and is voluntarily provided by an owner and not requested by the association.”

I hereby authorize Blank Condominium Association, Inc. to release e-mail addresses, telephone numbers, facsimile numbers, and addresses of a unit owner other than as provided to fulfill the association’s notice requirements, for the purposes of producing a unit owner directory to be published and made available to unit owners, their guests and invitees..

I hereby authorize the release of information to the unit owners and tenants of Blank Condominium Association, Inc. This release shall constitute authorization for the release of information, as described below.

Date: ______

______

Name of Family Member/Parent/Legal Guardian [Print]

PLEASE PROVIDE THE FOLLOWING INFORMATION:

(1) Unit Owner’s Names:

______

(2) Unit Owner’s Condominium Unit:

______

(3) Unit Owner’s Telephone Number(s):

______

______

______

______

(4) Unit Owner’s Facsimile Number:

______

______

______

(5) Unit Owner’s E-mail Address:

______

______

______

(4) Unit Owner’s Permanent Address (if not located at condominium):

______