Confidential Sensitive Data Form. This is a Arizona form and can be use in Yavapai Local County.
Tags: Confidential Sensitive Data Form, Arizona Local County, Yavapai
READ THIS FIRST, BEFORE YOU COMPLETE ANY FORMS IN YOUR PACKET MOST COURT FILES ARE OPEN TO THE PUBLIC FOR REVIEW, EITHER PERSONALLY OR ELECTRONICALLY. Pursuant to Rule 43(G), Arizona Rules of Family Law Procedure, effective January 1, 2006, before filing any paper containing sensitive data with the court, the filing party shall omit or otherwise redact the sensitive data unless they are specifically requested by the court. If the sensitive data are specifically requested by the court, the filer shall record the requested information on a separate sensitive data form which shall be maintained by the clerk as a confidential record. You are ENCOURAGED to use the attached form whenever “CONFIDENTIAL SENSITIVE DATA” is requested in paperwork, rather than list that information in the document filed with the Court that will be available for public scrutiny. The Confidential Sensitive Data Form(s) in your case will be maintained electronically and sealed and may be viewed only by the Court and court staff, the parties to the case and their attorneys, and Clerk’s Office staff, except as may be otherwise ordered by the Court. DEFINITION: “SENSITIVE DATA” includes the following: A) B) C) Social Security number; Bank account number, credit card number, or other financial account numbers; Driver's License number INSTRUCTIONS FOR FORM USE: Wherever “sensitive data” is required in a document that will be filed with the Court, write in “SEE CONFIDENTIAL SENSITIVE DATA FORM.” Make sure you write in the appropriate “sensitive data” on the Confidential Sensitive Data Form. Whenever new information is needed to supplement the record in a case, a party should file with the Clerk’s Office an updated sensitive data form (including all previously disclosed sensitive data, plus any additional sensitive data required to be filed in the case). When including social security, account or any personal indentifying numbers on a form, use only the last four digits. ANY PARTY WHO INCLUDES “SENSITIVE DATA” IN DOCUMENTS FILED WITH THE COURT, OTHER THAN ON A CONFIDENTIAL SENSITIVE DATA FORM, DOES SO AT THE PARTY’S OWN RISK. Rev. 1/2009 American LegalNet, Inc. www.FormsWorkFlow.com Name: Mailing Address: City, State, Zip Code: Daytime Phone Number: Evening Phone Number: Representing: State Bar Number: [ ] Self [ ] Petitioner [ ] Respondent ARIZONA SUPERIOR COURT, COUNTY OF YAVAPAI Case No. Petitioner ATLAS No. CONFIDENTIAL SENSITIVE DATA FORM Respondent A. Personal Information: Name Date of Birth Social Security Number Driver's License Number Petitioner: Respondent: Child: Child: Child: Child: B. Financial account numbers (including credit cards, financial institution accounts, investments, debts): Financial Institution Type of Account Name(s) on Account Account # C. Pension and retirement accounts (including IRAs, 401 (k)s): Financial Institution Type of Account Name(s) on Account Account # D. Life insurance policies: Insurance Company Policy # Superior Court of Arizona January 2009 Type of Policy Name(s) on Policy Page 2 of 2 Con.Sen.Data American LegalNet, Inc. www.FormsWorkFlow.com