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Request For Confidentiality Form. This is a Florida form and can be use in Santa Rosa Local County.
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Tags: Request For Confidentiality, Florida Local County, Santa Rosa
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
:
TO:
Calendar No.
REQUEST FOR CONFIDENTIALITY
:
JUDICIAL SUBPOENA
Plaintiff(s)
Mary M. Johnson
Clerk of Circuit Court
Santa Rosa Co unty -against-
NOT E: Document must be an
origina l.
:
:
I am filing this request for confidentiality in the Santa Rosa County Officials Records in accordance with Florida
Statutes 119 .07(3)(I)(2). I hereby sw ear or affirm that the follow ing inform ation is true and correct.
:
.
I attest that I am an individual cov ered und er 119 -07(3)(i)(1)as:
Defendant(s) (current or former)
I am a
:
. . . . . . . I am. a. spouse .of .a . . . . . . . . . . . . . . . . . . . . . . . . . . . . (current or former)
... ..... .
.....
I am a child of a
(current or former)
Law enforcement employee
THE PEOPLE OF THE STATE OF NEW YORK
county law enforcement
correctional
municipal law enforcement
correctional probation
TO
Dept. of Children and Families investigative employee whose duties include:
abuse
neglect
exploitation
fraud
theft
other criminal activities
Dept. of
GREETINGS: Revenue or Local G overnment employee with responsibility for:
revenue co llection enforcement
child support enforcement
WE COMMAND YOU, that all business and excuses being laid)aside, you and each of you attend before
Justice or Judge (state type:
,
the Honorable
at the
Court
located at
County State Attorney or State Prosecutor (state type:
of
)
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
Firefighter
Code Enforcement Officer
or adjourned date, to testify and Code evidence as a witness in this action on the part of the
give Inspector
PLEASE PRINT CLEARLY OR U SE A TYPE WR ITER TO C OM PLETE T HE FOLLOW ING LINES:
My full name is:
Your failure to comply with this subpoena is punishable as a contempt
Other names that I behalf used:
the party on whosemay havethis subpoena was issued for a maximum penalty of
of court and will make you liable to
$50 and all damages sustained as a
result of your failure to comply.
Hom e address (including, city, state and zip code):
Witness, Honorable
Social
Court inSecurity Number:
County,
, one of the Justices of the
Telephone num ber:
day of
, 20
The information provided on this request for confidentiality is itself to be kept confidential. The information may
only be used by the Santa R osa C ounty C lerk’s staff in order to pro cess my request for co nfidentiality. I agree to
indemnify and hold blameless the Santa Rosa County Clerk and the Clerk’s staff for actions or reactions that be the
(Attorney must sign above and type name below)
direct or indirect result of my request for confidentiality. Further, I agree to personally identify those documents of
record pertaining to me.
Signature of Individual:
Date:
Attorney(s) for
State of Florida
County of Santa Rosa
Sworn to (or affirmed) and subscribed befo re me this
day of
Office
or produced identification
Type of identification produced:
, 20
by
and P.O. Address
Notary Public.
Telephone No.:
(THIS PAGE TO BE COMPLETED DURING A VISIT TO THE SANTA ROSA COUNTY CLERK’S OFFICE)
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
Index No.
Calendar No.
DOCUMENTS TO BE COPIED AND MODIFIED FOR CONFIDENTIALITY
Plaintiff(s)
:
JUDICIAL SUBPOENA
As a re sult of my re view of the Official Rec ords of Santa Ro sa Co unty, I here by agree that the Santa Rosa Co unty
-against:
Clerk’s Official R ecords staff has my pe rmission to modify a c opy o f the follow ing do cuments in accord ance with
the particulars o f Section 119.07 (3)(I)(1). I understand that the mo dified copy w ill be made av ailable to the public
:
without limitation.
The documents that pertain to me follow:
:
Date Recorded
Instrument number
Defendant(s)
:
......................................................
Book
Page
THE PEOPLE OF THE STATE OF NEW YORK
TO
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and 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.
Signature:
Witness, Honorable
Printed
Court in Name:
County,
, one of the Justices of the
day of
, 20
Date Signed:
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
