IN THE CIRCUIT/COUNTY COURT OF THE SEVENTH JUDICIAL CIRCUIT IN AND FOR VOLUSIA COUNTY, FLORIDA _______________________ Plaintiff(s), v. _______________________ Defendant(s). _________________________________/ Case No._________________________ Notice of Confidential Information Within Court Filing Pursuant to Florida Rule of Judicial Administration 2.420(d)(2), the filer of a court record at the time of filing shall indicate whether any confidential information is included within the document being filed; identify the confidentiality provision that applies to the identified information; and identify the precise location of the confidential information within the document being filed. Title/Type of Document(s): _______________________________________________________ Indicate the applicable confidentiality provision(s) below from Rule 2.420(d)(1)(B), by specifying the location within the document on the space provided: If more space is needed, specify the location here:________________________________________________________ _____________________________________________________________________________ _____ Chapter 39 records relating to dependency matters, termination of parental rights, guardians ad litem, child abuse, neglect, and abandonment. §39.0132(3), Fla. Stat. (If the document is filed within a Chapter 39 case, this form is not required.) _____ Adoption records. §63.162, Fla. Stat. (If the document is filed within a Chapter 63 adoption case, this form is not required.) _____ Social Security, bank account, charge, debit, and credit card numbers in court records. §119.0714(1)(i)­(j), (2)(a)­(e), Fla. Stat. (Unless redaction is requested pursuant to §119.0714(2), this information is exempt only as of January 1, 2012.) _____ HIV test results and patient identity within the HIV test results. §381.004(3)(e), Fla. Stat. _____ Sexually transmitted diseases - test results and identity within the test results when provided by the Department of Health or the department's authorized representative. §384.29, Fla. Stat. _____ Birth and death certificates, including court-issued delayed birth certificates and fetal death certificates. §§382.008(6), 382.025(1)(a), Fla. Stat. _____ Identifying information in petition by minor for waiver of parental notice when seeking to terminate pregnancy. §390.01116, Fla. Stat. (If the document is filed within a Ch. 390 waiver of parental notice case, this form is not required.) _____ Identifying information in clinical mental health records under the Baker Act. 1 American LegalNet, Inc. www.FormsWorkFlow.com §394.4615(7), Fla. Stat. _____ Records of substance abuse service providers which pertain to the identity, diagnosis, and prognosis of and service provision to individuals who have received services from substance abuse service providers. §397.501(7), Fla. Stat. _____ Identifying information in clinical records of detained criminal defendants found incompetent to proceed or acquitted by reason of insanity. §916.107(8), Fla. Stat. _____ Estate inventories and accountings. §733.604(1), Fla. Stat. _____ Victim's address in domestic violence action on petitioner's request. §741.30(3)(b), Fla. Stat. _____ Information identifying victims of sexual offenses, including child sexual abuse. §§119.071(2)(h), 119.0714(1)(h), Fla. Stat. _____ Gestational surrogacy records. § 742.16(9), Fla. Stat. _____ Guardianship reports and orders appointing court monitors in guardianship cases. §§744.1076, 744.3701, Fla. Stat. _____ Grand jury records. Ch. 905, Fla. Stat. (If the document is filed in a Ch. 905 grand jury proceeding, this form is not required.) _____ Information acquired by courts and law enforcement regarding family services for children. §984.06(3)­(4), Fla. Stat. (If the document is filed in a Ch. 984 family services for children case, this form is not required.) _____ Juvenile delinquency records. §§985.04(1), 985.045(2), Fla. Stat. (If the document is filed in a Ch. 985 juvenile delinquency case, this form is not required.) _____ Information disclosing the identity of persons subject to tuberculosis proceedings and records of the Department of Health in suspected tuberculosis cases. §§392.545, 392.65, Fla. Stat. DATED: ________________________ [Signature] Printed name_________________________ Address_______________________________ Phone number________________________ Fax number__________________________ Florida Bar No._______________________ CERTIFICATE OF SERVICE I certify that the original was filed with the Clerk of the Court and that a copy of this document was furnished by ( ) U.S. mail ( ) hand delivery or ( ) facsimile to [include all parties and affected non-parties]____________________________________________________________________ _____________________________________________________on _____________, 20_____. ____________________________________ [Signature] Note: The clerk of court shall review filings identified as containing confidential information to determine whether the information is facially subject to confidentiality under the identified provision. The clerk shall notify the filer in writing within 5 days if the clerk determines that the information is NOT subject to confidentiality, and the records shall not be held as confidential for more than 10 days, unless a motion is filed pursuant to subdivision (d)(3) of the Rule. Fla. R. Jud. Admin. 2.420(d)(2). 2 American LegalNet, Inc. www.FormsWorkFlow.com