South Orange, MT · Essex County
Protected Person Disclosure Form – MOD IV Data
South Orange property owners use this form to request and authorize disclosure of protected property information to a named individual or corporation for a stated purpose.
What this form is
This form lets a South Orange property owner request and authorize the Township to disclose protected property information to a named individual or corporation for a stated purpose. It asks for the owner’s name, property address and block, lot, and qualifier, along with the recipient and intended use. The owner certifies the information is protected and signs and dates the request.
Who needs it
A South Orange property owner seeking to authorize disclosure of protected property information to a specified individual or corporation needs this form.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This form is signed and dated without a notary; it does not mention any notarized or sworn attachment or related step.
How to submit this form
- 1
Download The Form
Download the Protected Person Disclosure Form PDF.
- 2
Complete The Form
Print your name and provide the property address, block, lot, qualifier, recipient, and intended purpose.
- 3
Sign And Date
Sign and date the form as the property owner.
- 4
Submit To The City
Submit the completed form to the city department named on it; check the city website for current contact details.
Frequently asked questions
- What does the Protected Person Disclosure Form do?
- It lets a property owner request and authorize South Orange to disclose protected property information to a named individual or corporation for a stated purpose.
- What information does the form ask for?
- It asks for the property owner’s name, property address, block, lot, and qualifier, as well as the recipient, intended purpose, signature, and date.
- Do I need a notary for the Protected Person Disclosure Form?
- No. The form calls for the property owner’s signature and date and does not mention a notarized or sworn attachment or related step.
- How do I submit the Protected Person Disclosure Form?
- The form does not provide submission instructions. Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Protected Person Disclosure Form – MOD IV Data doesn’t need a notary — but if you have another South Orange form that does, a commissioned online notary can help.