INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(h), REQUEST FOR CONFIDENTIAL FILING OF ADDRESS (06/12) When should this form be used? If you fear that disclosing your address would put you in danger because you are the victim of sexual battery, aggravated child abuse, aggravated stalking, harassment, aggravated battery, or domestic violence, you should complete this form and file it with the clerk of the circuit court. This form should be typed or printed in black ink. After completing this form, you should file the original with the clerk of the circuit court in the county where your petition was filed and keep a copy for your records. Instructions for Florida Supreme Court Approved Family Law Form 12.980(h), Request for Confidential Filing of Address (06/12) American LegalNet, Inc. www.FormsWorkFlow.com IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division: __________________, Petitioner, and __________________, Respondent. REQUEST FOR CONFIDENTIAL FILING OF ADDRESS I, {full legal name} maintain and hold as confidential, the following address: , request that the Court Address City Telephone (area code and number) State Zip This request is being made for the purpose of keeping the location of my residence unknown for safety reasons pursuant to section 119.071(2)(j)1, Florida Statutes. Dated: Signature CLERK’S CERTIFICATE AS TO REQUEST FOR CONFIDENTIAL FILING OF ADDRESS I, , as Clerk of the Circuit Court, do hereby certify that I received and filed the above and will keep the above address confidential, subsequent to further order of the Court relative to such confidentiality. CLERK OF THE CIRCUIT COURT (SEAL) By: Deputy Clerk Florida Supreme Court Approved Family Law Form 12.980(h), Request for Confidential Filing of Address (06/12) American LegalNet, Inc. www.FormsWorkFlow.com