JOSEPH ABRUZZO
CLERK OF
THE
CIRCUIT
COURT
& COMPTROLLER
PALM BEACH
COUNTY
Request for Permanent Removal of
Military Separation Document
(As provided by 295.186 f.s.)
Must appear in person and present valid government issued picture ID
NOTICE
Please be advised that once your request for removal is implemented, there will no longer be any record of the
removed document in the Official Records and such a process will be permanent and irreversible. Please
obtain as many certified copies of your separation document as you might need in the future before the
removal is made.
If you do not wish to have your military discharge document permanently removed from the Official Records, but
rather, removed only from the publicly available internet website, you may complete and submit a Request for Internet
Document Removal from under 119.071.
Requestor’s Initials: _______
REQUESTING PARTY NAME AND CONTACT INFORMATION:
Requestor’s Name:
Email Address: Phone Number:
Mailing Address:
City: State: Zip:
RELATIONSHIP TO PARTY NAMED ON DOCUMENT:
Self Widow/Widower Attorney
Personal Rep Executor Court Appointed Guardian
DOCUMENT TO BE REMOVED FROM THE OFFICIAL RECORDS:
Document Title O.R. Book/Page or CFN
Requestor’s Signature: Date:
Date Request Received by Recording SIA:
Processed by Deputy Clerk:
Name as Shown on Presenter’s Valid ID:
Type of ID Presented:
Expiration Date Shown on ID:
Recording Department
205 N Dixie Hwy, 4th Floor, Room 4.2500, West Palm Beach, FL 33401
(561) 355-2991
www.mypalmbeachclerk.com/privacy.aspx
click to sign
signature
click to edit
![]()
