Authorization for Release
(Click here to download document)
Open and Print the attached document
On the first line please print in black or blue ink: your First and Last legal name, SSN, and DOB.
On the second line. Print the word “Self”
On the third line you will write the address of the Urban Wellness store you are applying to:
2910 San Mateo Blvd #5 Albuquerque, NM 87110
4601 Paradise Blvd NW Suite H, Albuquerque, NM 87114
Next, you will sign the Applicant Signature space and Date.
** It is required that this document be notarized. If you do not have easy access to a notary let us know and we can assist as we have one on staff.
We RECOMMEND you drive to Santa Fe and hand deliver the document to the Dept. of Public Safety at 4491 Cerrillos Rd. Santa Fe, NM 87507. They will complete on the spot and hand back to you if nothing is on your record. If you do have any arrests, they will advise you that they need to hold on to it and they will mail it out once it’s processed. Usually 1-2weeks later. Requires payment of $15.00 using any payment method.
Once the document has been completed and notarized you have the option to mail the document to the PO Box address listed on top of the document. You will need to include a check or money order for $15.00. It’s advised to use a traceable carrier to ensure delivery.
NOTE: This process usually takes an additional two weeks processing time