IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA
Case No.:
Division:
___________________,
Petitioner,
and
__________________,
Respondent.
REQUEST FOR CONFIDENTIAL FILING OF ADDRESS
I, {full legal name} , request that the Court
maintain and hold as confidential, the following address:
Address
City State Zip
Telephone (area code and number)
This request is being made for the purpose of keeping the location of my residence unknown for safety
reasons pursuant to section 119.071(2)(j)1, section 741.30(3)(b)(a), section 784.046(4)(b)1, and section
784.0485(3)(b)1, Florida Statutes, or other statutory provision providing for the separate confidential
filing for safety reasons.
Dated: __________________________________________
Signature
CLERK’S CERTIFIC!TE !S TO REQUEST FOR
CONFIDENTIAL FILING OF ADDRESS
I, , as Clerk of the Circuit Court, do hereby certify that I
received and filed the above and will keep the above address confidential, subsequent to further order
of the Court relative to such confidentiality.
CLERK OF THE CIRCUIT COURT
(SEAL)
By:
{Deputy Clerk}
Florida Supreme Court Approved Family Law Form 12.980(h), Request for Confidential Filing of Address
(06/18)