6 0 0 COMMERCE STREET DALLAS, TEXAS 75202 (214) - 653 - 7301
FAX (214) - 653 - 6634 e-mail: Felicia.Pitre@dallascounty.org
website: www.dallascounty.org/distclerk/index.html
Social Security Number Redaction Form
In accordance with Section 552.147 (d) of the Texas Government Code, this form is provided for
the redaction of all but the last four digits of the Individual’s social security number.
Unless otherwise prevented by law, the Social Security numbers of the Individual will be
redacted from the specific documents identified by the Individual or the Individual’s legal
representative* below:
Individuals Name:
Phone: Email:
City: State: Zip:
Specific Document(s) from which the social security number should be redacted:
Cause Number: Styled:
Document Title File / Order Date Page # with SSN
By my signature below, I certify that I am the above named Individual, or the
Individual’s legal representative*, and I am at least 18 years of age. I request the
Dallas County District Clerk to redact the Individual’s social security number
from the document(s) listed above. I understand that not all social security
numbers are subject to redaction.
Signature: ___________________________________ Date:
*Name of Legal Rep.: Relationship:
Return form to DCRecords@dallascounty.org