ROGER D. EATON
CHARLOTTE COUNTY CLERK OF THE CIRCUIT COURT AND COMPTROLLER
350 EAST MARION AVENUE
PUNTA GORDA, FLORIDA 33950
10/14/2021 Version 2.2 Page 1 of 3
REQUEST FOR REDACTION OF EXEMPT PERSONAL INFORMATION FROM
NON-JUDICIAL PUBLIC RECORDS
I request to have exempt personal information removed from records maintained by the Charlotte County
Clerk of the Circuit Court and County Comptroller’s Office.
Current/former government agency employee in the category checked below
Spouse of a current/former government agency employee in the category checked below
Child of a current/former government agency employee in the category checked below
Protected individual requesting redaction in the category checked below
Check the appropriate item:
Victim of violent crime [s. 119.071(2)(j)1, F.S.]*
Victim of an incident of mass violence [s. 119.071(2)(o),
F.S.]**
Law enforcement officers or civilian staff, correctional
and correctional probation officers [s.
119.071(4)(d)2.a., F.S.]
Dept of Children and Family investigator [s.
119.071(4)(d)2.a., F.S.]
Dept of Health investigator of child abuse or neglect [s.
119.071(4)(d)2.a., F.S.]
Dept of Revenue or local government child support
collection/enforcement personnel [s. 119.071(4)(d)2.a.,
F.S.]
Florida Department of Financial Services investigative
personnel [s. 119.071(4)(d)2.b., F.S.]
Office of Financial Regulation’s Bureau of Financial
Investigations investigative personnel [s.
119.071(4)(d)2.c., F.S.]
Firefighter [s. 119.071(4)(d)2.d., F.S.]
Justice or judge [s. 119.071(4)(d)2.e., F.S.]
State attorney and ASAs [FS 119.071(4)(d)2.f., F.S.]
Statewide prosecutor and asst. statewide prosecutors
[s. 119.071(4)(d)2.f., F.S.]
General or Special Magistrate [s. 119.071(4)(d)2.g,F.S.]
Judge of Compensation Claims, Administrative Law
Judge [s. 119.071(4)(d)2.g, F.S.]
Child Support Hearing Officer [s. 119.071(4)(d)2.g,F.S.]
Local Govt. or Water Mgt. District Human resources
manager/assistant manager [s. 119.071(4)(d)2.h., F.S.]
Local Govt. or Water Mgt. District Labor or employee
relations manager/assistant manager [s.
119.071(4)(d)2.h., F.S.]
Code enforcement officer [s. 119.71(4)(d)2.i., F.S.]
Guardian ad litem [s. 119.71(4)(d)2.j., F.S.]
Juvenile probation/detention officer, house parent,
therapy provider, counselor and their supervisors [s.
119.071(4)(d)2.k., F.S.}
Public Defender and APDs [s. 119.071(4)(d)2.l., F.S.]
Criminal conflict counsel and civil regional counsel
[s. 119.071(4)(d)2.l., F.S.]
Dept of Business Regulation investigators and
inspectors [s. 119.071(4)(d)2.m., F.S.]
Tax collectors (current only) [s. 119.071(4)(d)2.n., F.S.]
Dept of Health personnel involved in eligibility,
investigation, prosecution, and inspection [s.
119.071(4)(d)2.o., F.S.]
Impaired practitioner consultants retained by an
agency [s. 119.071(4)(d)2.p., F.S.]
Emergency medical technician or paramedic [s.
119.071(4)(d)2.q., F.S.]
Agency inspector general office or internal audit
department employees with auditing or potential
criminal investigating or disciplinary duties [s.
119.071(4)(d)2.r., F.S.]
Addiction treatment facility director, manager,
supervisor, nurse, or clinical employee [s.
119.071(4)(d)2.s., F.S.]
Child advocacy center director, manager,
supervisor, clinical employee of [s. 119.071
(4)(d)2.t., F.S.]
Domestic violence center current or former staff
and advocates [s. 119.071(4)(d)2.u., F.S.]
U.S. Attorney and AUSAs [s. 119.071(5)(i)1., F.S.]
U.S. Judge or U.S. Magistrate [s. 119.071(5)(i)1., F.S.]
Public guardian and employees with fiduciary
responsibilities [s. 744.21031, F.S.]
*Attach official verification of crime (i.e. police report or
injunction)/ 5-year renewable exemption.
**Names of Spouse/children for marked individuals are
not exempt
Note: Grantor, grantee, or party names cannot be
removed from Official Records unless they contain
ROGER D. EATON
CHARLOTTE COUNTY CLERK OF THE CIRCUIT COURT AND COMPTROLLER
350 EAST MARION AVENUE
PUNTA GORDA, FLORIDA 33950
10/14/2021 Version 2.2 Page 2 of 3
REQUESTOR CONTACT INFORMATION
Printed Name:
Telephone Number: __________________________________________________________
Email address: __________________________________________________________
INFORMATION TO BE REDACTED
Address where I (or qualifying spouse or child) reside (physical, mailing or street address):_______________
__________________________________________________________________________________________
The following additional address information for address where I reside: legal property description (consider
title implications), parcel identification number, plot identification number, neighborhood name and
lot number, GPS coordinates, other description property information that may reveal home address:
_______________________________________________________________________________________________
Telephone Number(s)
Social Security Number (do not list SSN) / Date of Birth:
Place(s) of Employment/Location: _______________________________________________________________
Name and Location of School/Daycare Facility of child): ______________________________________________
Personal assets (crime victim): __________________________________________________________________
WARNING: There may be consequences to redacting information on a public record, which is a risk undertaken by
the requestor. Only the documents identified by the requestor will be redacted. Once redaction is requested and
completed, future redactions require an additional redaction request. **Grantor, grantee, or party names cannot be
removed, unless the street address is included in the name, such as in a Trust or LLC. (Section 28.2221(2)(b), Florida
Statutes.)
PUBLIC RECORD: This form is itself a public record. If a copy of it is requested, all exempt information contained in
this form will be redacted.
DOCUMENTS TO BE REDACTED
The following section is to be completed during or after a visit to the Charlotte County Clerk and Comptroller’s
Office at CharlotteClerk.com or 350 E. Marion Ave. Punta Gorda, FL 33950.
As a result of my review of the Official Records of the Charlotte County Clerk and Comptroller’s Office, I
hereby agree that the Charlotte County Clerk and Comptroller’s Office staff has my permission to modify a copy
of the following documents in accordance with FS 119.071. I understand that only the modified copy will be
made available to the public, unless otherwise ordered by a court of competent jurisdiction.
Instrument Number
Book Page
Document Title
ROGER D. EATON
CHARLOTTE COUNTY CLERK OF THE CIRCUIT COURT AND COMPTROLLER
350 EAST MARION AVENUE
PUNTA GORDA, FLORIDA 33950
10/14/2021 Version 2.2 Page 3 of 3
Documents Other Than Official Records:
RELEASE TO GOVERNMENTAL AGENCIES: An unredacted version of these documents will be provided to the
Property Appraiser and Tax Collector to allow them to perform their governmental duties and responsibilities. To
redact information held by the Property Appraiser or the Tax Collector you must make a written request to those
agencies directly under Section 119.071(4)(d)(4), F.S. To redact information held by the Property Appraiser call
(941)743-1498 or by the Tax Collector call (941)743-1350. If you wish to release your information to other
individuals or entities, please complete a Request to Release Redacted Information on Recorded Documents form.
RELEASE FOR TITLE SEARCHES: an unredacted version of these documents may be provided to title insurers, agents
or agencies and attorneys conducting title searches as authorized in section 28.2221(6)(b), F.S.. Notice of any title
search release will be sent to the most recent address on the recorded documents on the redaction request
provided by the requestor.
COURTESY NOTICE - RELEASE OF PRIOR REDACTIONS:
If you have previously requested protection of a home address that is no longer your residence, you are required by
Florida law to submit a written, notarized request to release the removed information. Please ask the Clerk or
Recorder for the Release form. *Releases for other Florida counties must be submitted directly to that county.
Signature Date
STATE OF FLORIDA
COUNTY OF _____________
Sworn to (or affirmed) and subscribed before me by means of physical presence or online notarization ,
this ___day of _______________________, 20_____ by ________________________________
______________________________________________.
___________________________________
NOTARY PUBLIC
__________________________________________
{Print, type, or Stamp Name of Notary Public}
____ Personally known, OR
