AUTHORIZATION FOR RELEASE OF INFORMATION
C
URRENTLY EXEMPT FROM PUBLIC RECORDS
INSTRUCTIONS: Complete all required information and check the action requested of the Property Appraiser’s Office to
authorize release of the Protected Addressee’s unredacted Property Record Card information. Section 119.071(4) Florida
Statutes requires this form to be signed in the presence of a notary prior to submittal.
This request is good for a one-time release of your information only. Future requests will require a separate form submission.
Protected Addressee Name: Phone:
Protected Parcel Address:
Or Parcel ID / Account Number:
I Authorize Release and/or Delivery via Email to Myself and/or My Spouse
Email:
Phone:
I Authorize Release and/or Delivery via Email to a Non-Owner/Third Party
Name:
Email:
Phone:
(affix Notary Seal in space below)
NOTARY AFFIRMATION
ST
ATE OF _________________________________
COUNTY OF ______________________________
The foregoing instrument was acknowledged before me by
means of ( )physical presence or ( )online notarization this
_________ day of ______________________________, 20_______, by
Print Protected Addressee Name
Protected Addressee Signature (in presence of Notary)
Type and Number of Identification Produced
Signature of Notary
Rev.02/20 Page 1 of 1
