Dallas County Clerk and District
Clerk
Social Security Number Redaction
Form
In accordance with Section 552.147 (d) of the Texas Government Code, this form is provided for the
redaction of all but the last four digits of the Individual’s social security number.
Unless otherwise prevented by la w, the Social Security numbers of the Individual will be redacted from
the specific documents identified by the Individual or the Individual’s legal representative* below.
Individual’s Name:
Phone #: (
)
Address:
City:
State:
Zip Code:
Specific Document(s) from which the social security number should be redacted:
C
AUSE
N
UMBER
(if applicable):
FILE DATE /
PAGE #
D
OCUMENT TITLE DATE OF ORDER WITH SS#
By my signature below, I certify that I am the above named Individual, or the Individual’s legal representative*,
and I am at least 18 years of age. I request the Dallas County Clerk
Dallas County District Clerk
redact the Individual’s social security number from the document(s) listed above. I understand that not all social
security numbers are subject to redaction.
Signature:
Date:
*Name of Legal Rep.:
Relationship:
George Allen Courts
Building
600 Commerce St., Suite 101, Dallas, TX
75202
Voice (214) 653-7301 Fax (214)
653-6634
Attn: Jesusita Tovar
jesustia.tovar@dallascounty.org
click to sign
signature
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