REQUEST FOR SOCIAL SECURITY OR ACCOUNT NUMBER* REMOVAL *includes bank account, debit, charge, or credit card number Name of Holder of SSN/Account Number: ________________________________________________ Phone Number: ________________________________________________ Relationship to Requester: Self Attorney Legal Guardian For redaction/removal of SSN or Account Number from an Official Record image on a publicly available internet website, please provide the following information: Instrument (File) Number Book / Page Number Document Type Signature: ________________________________________________ Date: _______________________ Printed Name: _____________________________________________ Mailing Address: Clerk of Court Attn: Official Records P.O. Box 1030 Ocala, FL 34478 Hand Delivery: Clerk's Annex Building Official Records Dept, Rm. 124 19 NW Pine Avenue Ocala, FL Fax Number: Official Records (352)671 5629 For Office Use Only: Date Received: _________________________ Date Completed: _______________________ Images Modified By: _____________________ American LegalNet, Inc. www.FormsWorkFlow.com