REQUEST FOR SOCIAL SECURITY NUMBER REDACTION Pursuant to Section 552.147 of the Government Code, I ______________________________________________, hereby request the District Clerk of Galveston County, Texas to redact and/or remove from public access; within a reasonable period of time after the date this form is completed and presented to the same, all but the last four (4) digits of the social security number of ______________________________________________________________, contained in their official public records, including electronically stored information maintained by or under the control of the District Clerk in the document(s) I have specifically listed below. I further understand that this request may be refused if another law requires a social security number to be maintained in a government document. I request that all but the last four (4) digits of the social security as stated above be redacted from the following specific document(s): 1. Cause Number: Style of Case (Name of Parties): Document(s) description and page number within said document: A. Document Name: Page Number within document: B. Document Name: Page Number within document: C. Document Name: Page Number within document: 2. Cause Number: Style of Case (Name of Parties): Document(s) description and page number within said document: D. Document Name: Page Number within document: E. Document Name: Page Number within document: F. Document Name: Page Number within document: The undersigned hereby attest they are the owner or representative of the owner of the social security number requested to be redacted. Signature Phone Number PLEASE PRINT FULL NAME PLEASE PRINT FULL NAME DISTRICT CLERK GALVESTON COUNTY, TEXAS Address City/State Zip Code FOR OFFICE USE ONLY DATE REDACTION COMPLETED DEPUTY SIGNATURE American LegalNet, Inc. www.FormsWorkFlow.com