No information is available for this page. Important: Please read all instructions and information before completing and signing the form.An incomplete form might not be accepted. The secured party must complete and sign section A. 3. The form must be notarized. 4. Officer: Complete entire form and present to Defendant for signature. Give Defendant a completed copy. Signature Lines: Provide spaces for the releasor(s) and releasee(s) to sign and date the form. , Jr., III), please provide it in the "last name" blank with your last name. • You must complete this form if you want Delta Dental of Minnesota (DDMN) to give Protected Health.