Request Form For Number(s) Redaction For Redaction of Number(s) from an Alachua County Official Record Image on a Publicly Available Internet Website (Includes: Social Security, All complete bank account, debit, charge and credit card numbers) Please redact the number(s) belonging to _________________________________(one name) from the publicly available Internet website documents identified below. I am (a) ___the holder of the number(s); (b) ___ an attorney for the holder of number(s); (c) ___ legal guardian of the holder of the number(s). Printed Name: Signature: Date: Phone number: _________________________________ _________________________________ _________________________________ _________________________________(optional) Please specify: Instrument Number Book and Page Number Document Name Number Type Check Appropriate Box (es) Social Security Bank Account Credit Card / / / / / / Failure to provide complete and accurate information may result in an inability to process this request. Be advised that copies of the public record may have been disseminated prior to your request. It is the responsibility of the requestor to notify the Office of the Clerk of the Circuit Court of any additional or future documents the requestor desires to be redacted. Florida law requires that images and copies of recorded documents remain on file and available to the public in the office of the Clerk/ County Recorder. This request may be delivered in person, or by mail, facsimile or e-mail. Street Address: Alachua County Clerk of Court’s Office Recording Department - Room 151 12 S.E. First Street Gainesville, FL 32601 Mailing Address: Alachua County Clerk of Court’s Office Attn: Recording Department P.O. Box 600 Gainesville, FL 32602 Facsimile: E-mail Address: (352) 491-4649 For Office Use Only: Date sent to log / by clerk@alachua.co.fl.us _________________: Date completed / by _________________ Dated June 14, 2002 American LegalNet, Inc. www.USCourtForms.com