Request for Internet Document Removal
INSTRUCTIONS
Return completed form to:
Clerk of the Circuit Court & Comptroller, Palm Beach County
205 N. Dixie Hwy, Room 4.2500
P.O. Box 4177
West Palm Beach, FL 33402
Phone: 561.355.6214
Fax: 561.355.2633
www.mypalmbeachclerk.com
CCRPRIVACY@mypalmbeachclerk.com
APPLIES TO
• Military discharges
• Death certificates
• Court files, records, or papers relating to matters or cases governed by the:
1. Florida Rules of Family Law
2. Florida Rules of Juvenile Procedure
3. Florida Probate Rules
GENERAL INFORMATION
Requestor’s name:
Date:
Phone number or e-mail address: (required)
REQUEST FOR REMOVAL OF THE FOLLOWING OFFICIAL RECORD DOCUMENT IMAGES FROM THE CLERK
OF THE CIRCUIT COURT & COMPTROLLER’S PUBLIC WEBSITE*
BOOK & PAGE** DOCUMENT TYPE
* The Clerk shall only remove documents specifically identified in this request.
** Please visit our website at www.mypalmbeachclerk.com, Official Records, to locate your documents.
Please note that we are continually increasing our digital image library to include records from prior years. We ask
that you periodically check the online Official Records listing for documents that may contain private personal
information.
OFFICIAL USE ONLY
Date request received by HUB______________________ Date request received by dept______________________
Date request completed__________________________ Clerk processing request___________________________
Revised 01/05/21
