Telephone Number Date Signed Signature of Requester This form is a public record, and the information you provide may be released in response to a public records request. Updated: 2/26/2019 REQUEST TO REDACT PERSONAL INFORMATION Pursuant to Ohio Revised Code 149.45(C)(1), an individual may request that a public office or a person responsible for a public office222s public records redact specific types of personal information of that individual from any record made available to the general public on the internet. An individual who makes a request for redaction shall specify the personal information to be redacted and provide any information that identifies the location of that personal information. Upon receiving a request for redaction, a public office shall act within five (5) business days to either redact the requested information or provide a verbal or written explanation as to why a requested redaction is not practicable. Instructions : Complete entire form below and send directly to the public office that maintains the records to be redacted. Each individual requesting redaction is required to send the completed form to the appropriate public office. The Ohio Attorney General will not forward requests on behalf of the requesting individual. The Ohio Attorney General is not required or permitted to review and/or approve a request for redaction. I, ,request that the office of (print full name) (print name of public office) redact the following items of personal information from being made available to the public on the internet: (Please check all that apply) Social Security Number Driver222s License Number State Identification Number Tax Identification Number Checking Account Number Savings Account Number Debit Card Number Credit Card Number Demand Deposit Account Number Money Market Account Number Mutual Fund Account Number Any Other Financial or Medical Account Number For each item of personal information checked above, please identify the location of that information within any record made available by the office listed above to the public on the internet: Document Title & Description: Specific Web Address (URL): Location of Information within Document: (Use the second page of this form to identify additional locations of personal information items) Email Address Printed Name of Requester Full Address (Street, City, State, ZIP) Date Request Received / / (To be completed by the public office) American LegalNet, Inc. www.FormsWorkFlow.com Request to Redact Personal Information Page 2 This form is a public record, and the information you provide may be released in response to a public records request. Updated: 2/26/2019 Document Title & Description: Specific Web Address (URL): Location of Information within Document: Document Title & Description: Specific Web Address (URL): Location of Information within Document: Document Title & Description: Specific Web Address (URL): Location of Information within Document: Document Title & Description: Specific Web Address (URL): Location of Information within Document: Document Title & Description: Specific Web Address (URL): Location of Information within Document: American LegalNet, Inc. www.FormsWorkFlow.com