COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. : Request for Removal of Information from the JUDICIAL SUBPOENA Plaintiff(s) Manatee County Clerk of the Circuit Court’s Internet Site -against: (1) Name of Requestor _____________________________________ Phone # _________________ (2) Address : ______________________________________________________________ ______________________________________________________________ : (3) Defendant(s) Relationship to the person’s whose information is being removed: : . . . . . [. . . . Self . . . . . . [. . . ]. Attorney . . . . . . . . .[ . . . .Legal .Guardian, specify _____________________ ....... ] ... ] .... ....... (4) Please check [x] the information requested to be removed: THE PEOPLE OFSecurity Number ………… YORK blacked-out from image on website only [ ] Social THE STATE OF NEW will be [ ] Bank Account number…………… will be blacked-out from image on website only ] Credit/Charge Card Number…… will be blacked-out from image on website only [ ] Debit Card Number ……………… will be blacked-out from image on website only [ ] Death Certificates……………… Entire image will be blacked-out from website only [ ] Court Records** ………………Entire image will be blacked-out from website only [ ] Military Discharge………………Entire image will be blacked-out from website only GREETINGS: [ ] Military Discharge***…………Entire image and data will be completely removed from Public Records TO [ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before or removed from the Official Record, you must provide the (5) Honorable for this information to be blacked-out at the the In order Court exact location by completing the information below each time the information appears in the document. located at County of in room , on the # day of Document 20 , Type , at o'clock in the noon, be Removed Book # Page Information Requested toand at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to _____________________________________________________________________________________ the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a _____________________________________________________________________________________ result of your failure to comply. (6) In order for this information to be blacked-out or removed from the Court Record, you must provide the exact location Honorable Witness, by completing the information below each time the information appears in the document. , one of the Justices of the Court in Book # County, Page # day of , 20 Document Type Information Requested to be Removed _____________________________________________________________________________________ (Attorney must sign above and type name below) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Attorney(s) for (7) Signature ______________________________________________ Date _________________________ (8) Print Name ____________________________________________________________________________ Office and P.O. Address ------------------------------------------------------------------- For Official Use Only ---------------------------------------------------------------Date Request Received _____________________ Received by _________________________________________ Approved [ ] Denied [ ] Date Request Completed / Denied ____________________ Completed by _______________________________________________________ Reason of Denial _____________________________________________________________________________________________________ Notified Requestor Date ___________________ By ____________________________________________________ [ ] by phone [ ] by mail Telephone No.: ** These include court records relating to matters or cases governed by the Facsimile No.: Florida Rules of family Law, the Florida Rules of Juvenile Procedure, or the Florida Probate Rules. E-Mail Address: Mobile Tel. No.: *** Requests must be made at the Clerk’s office in person, with appropriate identification. Request may be made by a widow/widower, attorney or personal representative. American LegalNet, Inc. www.USCourtForms.com ,