Fillable Form 119.: REQUEST FOR REDACTION OF EXEMPT PERSONAL (Pinellas County Clerk of the Circuit Court and Comptroller)

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Form 119.: REQUEST FOR REDACTION OF EXEMPT PERSONAL (Pinellas County Clerk of the Circuit Court and Comptroller)

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BROWSE PINELLAS COUNTY CLERK OF THE CIRCUIT COURT AND COMPTROLLER FORMS

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Page 1 of 2
REQUEST FOR REDACTION OF EXEMPT PERSONAL INFORMATION FROM PINELLAS COUNTY
I request to have exempt personal information removed from records maintained by the Pinellas County
Clerk’s/Comptroller’s Office.
Exempt information held under FS 119.071 or FS 493.6122 or FS 741.465 as (select all that apply):
Current/former government agency employee in the category checked below
Spouse of a current/former government agency employee in the category checked below
Child of a current/former government agency employee in the category checked below
Check the appropriate item:
Victim of violent crime [FS 119.071(2)(h)1]
Victim of an incident of mass violence [FS 119.071(2)(o)]
Child advocacy center director, manager, supervisor,
clinical employee of [FS 119.071(4)(d)2.t.] (eff. 7/1/18)
Law enforcement officers, civilian staff, correctional
and correctional probation officers
[FS 119.071(4)(d)2.a.]
Dept of Children and Family investigator [FS
119.071(4)(d)2.a. (I)
Dept of Health investigator of child abuse or neglect [FS
119.
071(4)(d)2.M.]
Dept of Revenue or local government child support
collection/enforcement personnel [FS 119.071(4)(d)2.a.]
Florida Department of Financial Services investigative
personnel [FS 119.071(4)(d)2.b.]
Office of Financial Regulation’s Bureau of Financial
Investigations investigative personnel [F.S.
119.071(4)(d)2.c.]
Firefighter [FS 119.071(4)(d)2.d.]
Justice or judge [FS 119.071(4)(d)2.e.]
State attorney and ASAs [FS 119.071(4)(d)2.f.]
Statewide prosecutor and asst. statewide prosecutors
[FS 119.071(4)(d)2.f.]
General or Special Magistrate [FS 119.071(4)(d)2.g]*
Judge of Compensation Claims, Administrative Law
J
udge [FS 119.071(4)(d)2.g]*
Child Support Hearing Officer [FS 119.071(4)(d)2.g]
Local Govt. or Water Mgt. District Human resources
manager/assistant manager [FS 119.071(4)(d)2.h.]
Local Govt. or Water Mgt. District Labor or employee
r
elations manager/assistant manager [FS
119.071(4)(d)2.h.]
Code enforcement officer [FS 119.071(4)(d)2.i.]
Guardian ad litem [FS 119.071(4)(d)2.j.]
Juvenile probation/detention officer, house parent,
therapy provider, counselor and their supervisors [FS
119.071(4)(d)2.k.]
Public Defender and APDs [FS 119.071(4)(d)2.l.]
Criminal conflict counsel and civil regional counsel [FS
119.
071(4)(d)2.l.]
Dept of Business Regulation investigators and
inspectors [FS 119.071(4)(d)2.m.]
Tax collectors (current only) [FS 19.071(4)(d)2.n.]*
Dept of Health personnel involved in eligibility,
investigation, prosecution, and inspection [FS
119.071(4)(d)2.o.]
Impaired practitioner consultants retained by an agency
[
F.S. 119.071(4)(d)2.p.]
Emergency medical technician or paramedic [FS
119.071(4)(d)2.q.]
Agency inspector general office or internal audit
department employees with auditing or potential
criminal investigating or disciplinary duties [FS
119.071(4)(d)2.r.]
Addiction treatment facility director, manager,
supervisor, nurse, or clinical employee [FS
119.071(4)(d)2.s.]
U.S. Attorney and AUSAs [FS 119.071(5)(i)1.]
U.S. Judge or U.S. Magistrate [FS 119.071(5)(i)1.]
Member of US Armed Forces, reserve, or National
Guard, who served after 9/11/01 [FS 119.071(5)(k)1.]
Private Investigative, Private Security, and Repossession
Services- Class “C”, “CC”, “E”, “EE” Security Licensee [FS
493.6122]
Victim of Domestic Violence participating in the Address
Confidentiality Program [FS 741.465]
Public Guardians and employees with fiduciary
r
esponsibilities [FS 744.21031] (eff. 7/1/18)
NOTICE OF CONSEQUENCES AND LIMITATIONS OF REDACTION
This form is itself a public record. If a copy of it is requested, all exempt information contained in this
form will be redacted.
There may be consequences to redacting information on a public record. If you have questions
regarding the
potential consequences, you may wish to consult with an attorney.
Only the documents identified by the requestor will be redacted. Once redaction is requested and
completed, future redactions require an additional redaction request.
Page 2 of 2
REQUESTOR CONTACT INFORMATION
Printed Name: _________________________________________________________________________________
Telephone Number: ________________ Email address: _____________________________________________
See Section 119.071(4)(d) 1, Florida Statutes.
You must provide the book and pages below to be redacted. Future recorded documents require a new request.
INFORMATION TO BE REDACTED FROM THE OFFICIAL RECORDS
Instrument Number of document where exempt information located:
The following address(es) (physical, mailing, or street address),
You must check each item you would like redacted. The following additional address information, Legal description,
(consider title implications) ☐Parcel identification number, ☐Plot identification number, ☐Neighborhood name and Lot
Number ☐ other description property information that may reveal home address.
DOCUMENTS TO BE REDACTED
The following section is to be completed during or after a visit to the Pinellas County Clerk’s Office at
www.mypinellasclerk.org o
r the office at 315 Court Street, rm 150 Clearwater, FL 33756. Fax 727-464-4383
As a result of my review of the Official Records of the Pinellas County Clerk’s Office, I hereby agree that the Pinellas
County Clerk’s Office staff has my permission to modify a copy of the following documents in accordance with FS
119.071. I understand that only the modified copy will be made available to the public, unless otherwise ordered by a
court of competent jurisdiction. A separate release can be provided to authorize release of an unredacted document to
a named person or entity.
1st Document
Instrument Number OR Book and Page Date:
Document Title
2nd Document
Instrument Number OR Book and Page Date:
Document Title
3rd Document
Instrument Number OR Book and Page Date:
Document Title
4th Document
Instrument Number OR Book and Page Date:
Document Title
Documents Other Than Official Records:
(Note: redactions in court records must be made under Fla. R. Jud. Admin 2.420 either by a Notice of Confidential
Information if one of the authorized 22 items or by motion and order if not on the list of 22.)
Signature: _____________________________________ Date: ________________________________________
Name of Eligible Government Employee (if not requestor): __________________________________________
_______________________________________ ________________________________________
Job Title of Eligible Government Employee Employing agency
Revised 7/2019
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Form 119.: REQUEST FOR REDACTION OF EXEMPT PERSONAL (Pinellas County Clerk of the Circuit Court and Comptroller)

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Completed 15 January 2021

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