OR_F_Request for Authorized Release 012721
Office of Nikki Alvarez-Sowles, Esq.
Pasco County Clerk & Comptroller
OFFICIAL RECORDS DIVISION
REQUEST TO RELEASE REDACTED INFORMATION
PURSUANT TO F.S. 119.071
Pursuant to F.S. §119.0714(3)(f), in order for a person who is authorized under F.S. §119.071(4)(d)2 request an exemption from official
records, the requester 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.
THIS REQUEST IS TO AUTHORIZE THE RELEASE OF REDACTED RECORDS TO SPECIFIC INDIVIDUALS PURSUANT TO F.S. §119.071(4)(d)4
I , previously requested protection of
(Requestor)
the confidential information listed under F.S. 119.071(4)(d)2 of the following Book/Page
Numbers:
Book _Page
Book __________Page ________ ___
Book _Page
Book __________Page ____________
Book _Page
Book ____Page ____________
Book ________ _Page ___________ Book_________ _Page____________
I hereby authorize the Office of Clerk & Comptroller to send un-redacted copies of the above
listed Book & Page numbers to:
Authorized Party: ___________________________
A
ddress: ___________________________ OR Email: ____________________
___________________________
___________________________
Dat
e Requestor Signature
ACKNOWLEDGEMENT
STATE OF FLORIDA
COUNTY OF PASCO
SWORN TO (or affirmed) and subscribed before me by means of physical presence or
online notarization, this _____ day of ___________________, __________ by ______________.
Affiant Name
___________________________________________
Signature of Notary or Deputy Clerk
______________________________________________
Print/stamp commissioned name/Notary Public/Commission # SEAL
Personally Known or Produced Identification
(Check One)
Type of ID: ____________________________________
