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Confidentiality Requesting CONFIDENTIALITY REQUEST FOR VOTER REGISTRATION PURPOSES (Texas Secretary of State)

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17-11, 09/2019
Sections 552.1175, Gov’t Code
13.004(c), Election Code
CONFIDENTIALITY REQUEST FOR VOTER REGISTRATION PURPOSES
Pursuant to Section 552.1175 of the Government Code and 13.004(c) of the Texas Election Code, if you are one of the qualifying
individuals listed in Step 2 below, you may request that information in the voter registration records identifying your home address,
home telephone number, emergency contact information, date of birth, social security number, or whether you have family members
be restricted from public access. By completing and submitting this form to the County Voter Registrar’s Office
(https://www.sos.state.tx.us/elections/voter/votregduties.shtml) you are requesting the confidentiality of the voter registration
information as stated above. You must attach a photocopy of documentation showing that you are eligible for confidentiality. If you
want to rescind this confidentiality request, you must do so in writing to the County Voter Registrar’s Office.
Step 1:
Identify Person
Requesting
Confidentiality
Name Date of Birth
Residence Address (number and street)
City, State, Zip Code
VUID Number County of Residence
Step 2:
Qualification
(check one)
Peace Officer (as defined by Article 2.12, Code of Criminal Procedure) and spouse of
a peace officer;
County Jailer (as defined by §1701.001, Occupations Code);
Current or former employee of the Texas Department of Criminal Justice (or of t he
predecessor in function of the department or any division of t he department);
Commissioned Security Officer (as defined by §1702.002, Occupations Code);
A current or former District Attorney (DA), Criminal DA, County or Municipal Attorney
whose jurisdiction includes any criminal l aw or child protective services matters;
A current or former employee of a District Attorney (DA), Criminal DA, County or
Municipal Attorney whose jurisdiction includes any criminal law or child protective
services matters;
Officer/Employee of a
community
supervision and corrections department
established
under
Chapter 76 who perform
a duty
described by
§76.004(b),
Government
Code;
Criminal I
nvestigators of
the U.S.
as described by
Article 2.122(a),
Code of C
riminal
Procedure;
Police officers and inspectors of
the United States Federal
Protective Service;
Current
and former employees of
the office of t
he attorney
general
who are
or were
assigned to a division of
that
office the duties of w
hich involve law
enforcement;
Current
or former juvenile probation and detention officers certified by
the Texas
Juvenile Justice Department,
or the predecessors in function of
the department,
under
Title 12,
Human Resources Code;
Current
or former employees of a
juvenile justice program
or facility,
as defined by
§261.405,
Family
Code;
Current
or former employees of t
he Texas Juvenile Justice Department
or the
predecessors in function of t
he department;
Current
or former employees of t
he Texas Civil
Commitment
Office or of t
he
predecessor in function of
the office or a division of
the office;
A
firefighter,
volunteer firefighter,
or emergency
medical
services personnel;
Current
or former member of t
he US
Army,
Navy,
Air
Force,
Coast
Guard,
or
Marine Corps,
an
auxiliary
service of
one of t
hose branches,
or the Texas military
forces;
Officers commissioned by
the board of hos
pital
managers of t
he
Lubbock
County
Hospital
District
of L
ubbock
County,
Texas;
or
Note:
As
a federal
judge,
state judge
or spouse of
a judge,
you may
also complete form
BW9-2 (13.004(c)(5)).
_______________________________
__________________
_______________________________________ _ _________________
Step 2:
Qualification
Current or former CPS caseworkers, adult protective services caseworkers, or
investigators for DFPS or a current or former employee of a DFPS contractor
performing CPS, adult protective services, or investigative functions for the contractor
on behalf o f D FPS;
State officers elected statewide or a member of t
he legislature;
A
firefighter,
volunteer firefighter,
or emergency
medical
services personnel;
Current
or former member of t
he US
Army,
Navy,
Air
Force,
Coast
Guard,
or
Marine Corps,
an
auxiliary
service of
one of t
hose branches,
or the Texas military
forces;
Special Investigators as defined by Article 2.122, Code of Criminal Procedure;
Officers commissioned by
the board of hos
pital
managers of t
he
Lubbock
County
Hospital
District
of L
ubbock
County,
Texas;
or
Federal judges, state judges (as defined by §1.005, Election Code) and spouses of
federal or state judges.
Note:
As
a federal
judge,
state judge
or spouse of
a judge,
you may
also complete form
BW9-2 (13.004(c)(5)).
Step 3:
Evidence of
Status
I have attached a photocopy of documentation showing evidence of my qualification
(proof of the qualification claimed above on Step 2).
Step 4:
Sign and Date
I certify that the information in this document and any information attached are true and
correct to the best of my knowledge and belief.
Sign
Here► ____ Date ►___________________
Making a false statement on this form is a Class A misdemeanor or a state jail felony. Texas Penal Code §37.10.
Step 5:
Return this form
Return this form to: County Voter Registrar
____________________________________
____________________________________
Or fax to _____________________________
For Office
Use Only
Certificate # Documentation received? Yes No
Confidentiality Approved? Yes No
Voter Reg. Dept. Signature Date
Comments:
__________________________________________________________________________
Print
Reset
BW9-3, 09/2019
Sección 552.1175, Código del Gobierno
13.004(c), Código Electoral
SOLICITUD DE CONFIDENCIALIDAD PARA FINES DE REGISTRO DE VOTANTES
De conformidad con la Sección 552.1175 del Código Gubernamental y 13.004(c) del Código Electoral de Texas, si usted es una de las
personas calificadas que se enumeran en el Paso 2 a continuación, usted puede solicitar que esa información en los registros de
votantes que identifican su domicilio, número de teléfono de casa, información de contacto de emergencia, fecha de nacimiento,
número de seguro social o si tiene familiares, restringidos de acceso público. Al completar y enviar este formulario a la Oficina del
Registrador de Votantes del Condado (https://www.sos.state.tx.us/elections/voter/votregduties.shtml) usted está solicitando la
confidencialidad de la información de registro de votante como se indicó anteriormente. Usted debe adjuntar una fotocopia de la
documentación que demuestre que es elegible para la confidencialidad. Si desea rescindir esta solicitud de confidencialidad, debe
hacerlo por escrito a la Oficina del Registrador de Votantes del Condado.
Paso 1:
Identificar La
Persona Que
Solicita La
Confidencialidad
Nombre Fecha de Nacimiento
Dirección de Residencia (número y calle)
Ciudad, Estado, y Código Postal
Número VUID Condado de Residencia
Paso 2:
Calificación
(marque uno)
Oficial de la Paz (tal como se define en el Artículo 2.12, Código de Procedimiento
Penal) y cónyuge de un oficial de la paz;
Carcelero del Condado (tal como se define en la §1701.001, Código de
Ocupaciones);
Empleado actual o anterior del Departamento de Justicia Criminal de Texas (o del
predecesor en función del departamento o cualquier división del departamento);
Oficial de Seguridad Comisionado (tal como se define en §1702.002, Código de
Ocupaciones);
Un Fiscal de Distrito (DA) actual o anterior, Fiscal de Distrito Criminal, Abogado del
Condado o del Municipio cuya jurisdicción incluye cualquier derecho penal o asuntos
de servicios de protección de menores;
Un empleado actual o anterior de un Fiscal de Distrito (DA), Fiscal de Distrito
Criminal, Abogado del Condado o Municipal cuya jurisdicción incluye cualquier
derecho penal o asuntos de servicios de protección de menores;
Oficial/Empleado de un departamento de correcciones y supervision comunitaria
establecido por el Capítulo 76 quien realice un deber descrito por §76.004(b), Código
Gubernamental;
Investigadores Criminales de los Estados Unidos como se describe en el Artículo
2.122(a), Código de Procedimiento Penal;
Oficiales de policía e inspectores del Servicio Federal de Protección l de los Estados
Unidos;
Empleados actuales y anteriores de la oficina del fiscal general que son o fueron
asignados a una división de dicha oficina cuyas funciones incluyen la aplicación de la
ley;
Funcionarios actuales o anteriores de libertad condicional y de detención juvenil
certificado por el Departamento de Justicia Juvenil de Texas, o los predecesores en
función del departamento, bajo el Título 12, Código de Recursos Humanos;
Empleados actuales o anteriores de un programa o centro de justicia juvenil, tal como
se define en §261.405, Código de Familia;
___________________________________
____________________________________
____________________________________
_________________
_______________________________________ ________________
Paso 2:
Calificación
Empleados actuales o anteriores del Departamento de Justicia Juvenil de Texas o los
predecesores en función del departamento;
Empleados actuales o anteriores de la Oficina de Compromiso Civil de Texas o del
predecesor en función de la oficina o una división de la oficina.
Trabajadores de casos actuales o anteriores de CPS, trabajadores de casos de
servicios de protección para adultos, o investigadores para DFPS o un empleado
actual o anterior de un contratista de DFPS que realiza CPS, servicios de protección
de adultos, o funciones de investigación para el contratista en nombre de DFPS.
Oficiales estatales elegidos en todo el
estado o un miembro de la legislatura
Un bombero,
bombero voluntario
o personal
de servicios médicos de emergencia
Miembro actual
o anterior del
Ejército de
los Estados Unidos,
la Armada de los
Estados Unidos,
la Fuerza Aérea
de los Estados Unidos,
la Guardia
Costera de los
Estados Unidos,
o la Infanteriía de Marina de los Estados Unidos,
un servicio auxiliar
de una de esas ramas,
o las fuerzas militares de
Texas
Investigadores
especiales
tal co
mo
se define en el
Artículo 2.122, Código de
Procedimiento P
enal;
Oficiales comisionados por
la junta de gerentes de hospitales del
Distrito Hospitalario
del
Condado de Lubbock
del
Condado de Lubbock,
Texas;
o
Jueces federales,
jueces estatales (tal co
mo se define en §1.005,
Código Electoral)
y
cónyuges de jueces
federales
o estatales.
Nota:
Como juez
federal,
juez
estatal
o
cónyuge de un juez,
también puede completar
el f
ormulario BW9-2 (13.004(c)(5)).
Paso 3:
Prueba de
Estado
He adjuntado una fotocopia de la documentación que demuestra la evidencia de mi
calificación (prueba de la calificación reivindicada anteriormente en el Paso 2).
Paso 4:
Firma y Fecha
Certifico que la información contenida en este documento y cualquier información adjunta
son verdaderas y correctas a mi mejor saber y entender.
Firme
Aquí► Fecha ►
___________________
Hacer una declaración falsa en este formulario es un delito Clase A o una felonía de cárcel estatal. Código
Penal de Texas §37.10.
Paso 5:
Devuelva este
formulario
Devuelva este
formulario a:
Registrador de Votantes del Condado
O fax a:
_____________________________
For Office
Use Only
Certificate # _ Documentation received? Yes No
Confidentiality Approved? Yes No
Voter Reg. Dept. Signature _ Date_
Comments: _
_________________________________________________________________________
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Confidentiality Requesting CONFIDENTIALITY REQUEST FOR VOTER REGISTRATION PURPOSES (Texas Secretary of State)

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Completed 29 July 2020

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