TO: Chief of Police, City of Dallas, Texas. Signature of Affiant.All three options for releasing a lien require an original signature and must be dated; a copy will not be accepted. Electrical Contractor a. Complete and sign "Request for Temporary Utilities" form. b. South Dallas Government Center. The signature of a minor patient is required for the release of some of these items. Signature — Individual or personal representative's signature. Date — Enter the date the form is signed. Forms of Payment; Hours of Release of Vehicles; Proof of Insurance; Notice of Right to a Tow Hearing.