Copy/search Request Form - Florida
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1COPY/SEARCH – REQUEST FORM
DATE: _______________
TIME: _______________
RECEIPT # ____________________
BILL TO ESCROW ACCT
Recording or
Civil
EXEMPT per F.S. 28.345 or F.S. _______
BILL TO OTHER COUNTY DEPT ( Note: Must have check requisition attached)
CHECK VISA
CASH
MASTERCARD
DISCOVER
AMERICAN EXPRESS
Note: There is a 3.5% Service Charge for payment by credit cards.
(Complete for Escrow Accts., Credit Cards, Or For Records not immediately available for inspection/copies)
CREDIT CARD NUMBER: _________________________________ & Security Code ______________________
EXPIRATION DATE:_________________& Billing Address Zip Code____________________________________
CUSTOMER NAME on Credit Card (exactly how it appears on card)______________________________________
CUSTOMER TELEPHONE # (Residence/Business Only) _______________________________________________
ESCROW ACCT. Name (if applicable) ______________________________________________________________
MAILING ADDRESS: _____________________________________________________APT./STE# ____________
CITY _____________________________________________________________STATE_______ZIP____________
COPY PAGES AS INDICATED
INDICATE:
Case#/Case Type
COPY ENTIRE FILE
Plat Book/Page(s)
CERTIFY
Name (for MVR)
FAX
Name(s) & Years to be Searched
E-MAIL
________________________________________________
________________________________________________
________________________________________________
COMMENTS: _____________________________________________________________________________________
COPIES @ $1.00 EACH (Court records or Official Records)
COPIES @ .15 EACH
COPIES @ $.20 EACH (Internal Revenue Service)
CERTIFICATIONS @ $2.00 EACH
TRAFFIC MVR REPORT @ $7.00 EACH
FAX FEE @ $.25 PER PAGE
)
(Long Distance Only
SEARCH FEE @ $2.00 PER NAME, PER YEAR
Plat Tubes @ $3.50 each (holds up to 20 rolled pages)
PLAT COPIES @ $5.00 EACH ___PAPER Copy or ___Electronic Image (.tif format) & send via ___email ___disk ___ed
********************************************
PICK-UP BY CUST
MAIL
FAX TO:_______________
E-MAIL TO: _____________________
TOTAL # OF COPIES: _________________
TOTAL COPY FEE:
$____________
TOTAL # CERTIFIED: _________________
TOTAL CERTIFIED FEE:
$ ____________
TOTAL # PAGES FAXED: ______________
TOTAL FAX FEE (
):
$ ____________
Long Distance Only
TOTAL #NAMES/#YEARS SEARCHED: _____/_____
TOTAL SEARCH FEE:
$ ____________
TOTAL #PLAT COPIES: ________________
TOTAL PLAT COPY FEE:
$ ____________
TOTAL #MVR REPORTS: _______________
TOTAL MRV REPORT FEE:
$ ____________
POSTAGE (for mailing):
$ ____________
Customer Initials (Escrow Accts): __________
SPECIAL PACKAGING (for Mailing):
$ ____________
Location: ___FR___RSF___RC
CREDIT CARD SVC. CHRG:
$ ____________
TOTAL COST:
$____________
DATE COPY REQUEST COMPLETED: ___________ DEPUTY CLERK’S INITIALS: _____________
F:\!Department Share\FORMS\General\COPYREQ.doc Rev. 6/23/10
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