Fillable Office of Nikki Alvarez-Sowles, Esq. Pasco County Clerk (Pasco County Clerk, FL)

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Office of Nikki Alvarez-Sowles, Esq. Pasco County Clerk (Pasco County Clerk, FL)

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Request for Redaction of Information Pursuant to F.S. 119.071 – Protected Status R072320
1 of 2
Office of Nikki Alvarez-Sowles, Esq.
Pasco County Clerk & Comptroller
Official Records Division
REQUEST FOR REDACTION OF INFORMATION PURSUANT TO F.S. 119.071
– PROTECTED STATUS
Pursuant to F.S. §119.0714(3)(f), in order for a person who is authorized under F.S. §119.071(4)(d)2 to request an exemption from official
records, the requestor must submit a request to the office of the Clerk & Comptroller, and specify the document type, name, identification
number, and page number of the official record that contains the exempt information.
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.
I , proclaim that I am entitled
(Requestor)
to protection of the confidential information listed under this statute due to my service as noted
in F.S. 119.071(4)(d)2 as I am: (state position)
____________________________________________________________________________
Telephone Number: ________________________ Email address: _________________________
Address where I reside (physical, mailing, or street address:) ___
_____________________________________________________________________________
Please redact the following additional address information for where I reside:
legal property description (consider title implications) parcel identification number
plot identification number neighborhood name and lot number GPS coordinates
other descriptive property information that may reveal home address:
___
SSN Date of Birth Place(s) of Employment/Location:_______________________
Name/Location of School/Daycare Facility of Child: _________________________________
Photo of Requestor Personal assets (crime victim):____________________________
Include the following name(s) of my child(ren) if under 18 YOA:
___
_____________________________________________________________________________
Request for Redaction of Information Pursuant to F.S. 119.071 – Protected Status R072320
2 of 2
AGREEMENT
I understand that this form is a public record. If a copy is requested, all exempt information
contained herein will be redacted. I hereby agree to indemnify and hold harmless the Office of
Clerk & Comptroller and its staff for any direct or indirect claims or damages that may arise in
connection with this request for confidentiality. Further, I accept responsibility for identifying the
documents of record pertaining to me, my spouse, or my child(ren). Additionally, a
consequence of exercising this election is that documents evincing my ownership interests in
real property will not be available for viewing by the general public. In the event that I wish to
demonstrate my ownership interest in real property (e.g., to corroborate financial
disclosure, to facilitate title search, etc.), I acknowledge that I will have to submit a
written request for the release of the exempt information to the Office of Clerk &
Comptroller. The written request must be notarized and must specify the information to be
released and the party that is authorized to receive the information. Upon receipt of the written
request, the Office shall release the specified information to the party authorized to receive
such information. See F.S. §119.071(4)(d)4
I hereby request the removal of this information from the following official records documents:
Book _Page
Book __________Page ________ ___
Book _Page
Book __________Page ____________
Book _Page Book ____Page ____________
Book___________Page______________ Book__________Page______________
I am aware that ONLY the information listed in Florida Statutes may be removed
from public record.
___________ ________________________________
Date Signature
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Office of Nikki Alvarez-Sowles, Esq. Pasco County Clerk (Pasco County Clerk, FL)

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Completed 23 June 2021

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