Request Form For Confidential Filing Of Address (Page 2 of 2) in pdf

Request Form For Confidential Filing Of Address Page 2

IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,

IN AND FOR ______________________________ COUNTY, FLORIDA

Case No: ________________________

Division: ________________________

_________________________________,

Petitioner,

And

_________________________________,

Respondent.

REQUEST FOR CONFIDENTIAL FILING OF ADDRESS

I, {full legal name} _____________________________________, request that the Court

maintain and hold as confidential, the following address:

Address _______________________________________________________________________

______________________________________________________________________________

City ______________________________ State _____________________ Zip _______________

Telephone (area code and number) _________________________________________________

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 (12/10)

Request Form For Confidential Filing Of Address Page 2