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IN THE CIRCUIT COURT OF THE SIXTH JUDICIAL (Pinellas County Clerk of the Circuit Court and Comptroller)

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IN THE CIRCUIT COURT OF THE SIXTH JUDICIAL CIRCUIT OF THE STATE OF
FLORIDA IN AND FOR PINELLAS COUNTY
IN RE:
______________________________,
Alleged Vulnerable Adult,
______________________________,
Petitioner,
v. Case Number: _______________
UCN: ______________________
Division: ___________________
_____________________________,
Respondent.
____________________________________/
CONSENT FOR PETITIONER TO FILE ON BEHALF OF VULNERABLE ADULT
I consent to a Petition for Injunction being filed against _____________________________.
(Respondent)
I wish to designate __________________________________________ to petition on my behalf
for an injunction for protection against exploitation.
________________________________
Signature
_________________________________
Print Name
Address: ___________________________________________
___________________________________________________
Date: _______________________
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IN THE CIRCUIT COURT OF THE SIXTH JUDICIAL (Pinellas County Clerk of the Circuit Court and Comptroller)

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Completed 10 February 2021

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