Suppression of Public Information Form Please Note: You may be eligible under Florida Statutes, Chapters 119.07(3)(i) and 119.07(3)(i)2, to have your address and other specific personal information suppressed from our public records. If you qualify for this confidentiality exemption, you may submit a written request to the following address: Clerk of Courts Records Management Department P.O. Box 999 Titusville, Florida 32781-0999 Or e-mail to: FS119exemptionrequest@clerk.co.brevard.fl.us Please state the reason the information is to be suppressed, and provide the following information: Occupation ___________________________ If Police Officer, Badge Number __________ Full Name ________________________________________________ Address ________________________________________________ ________________________________________________ __________________________________________________________ Social Security Number _____________________________________ Drivers License Number ____________________________________ Date of Birth ______________________________________________ Note: It is the responsibility of the requester to provide requested Official Record Book and Page information and Case Numbers. ______________________________________________________________________________