REQUEST FOR CONFIDENTIAL FILING OF ADDRESS
INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.980(h), REQUEST FOR CONFIDENTIAL FILING OF ADDRESS
(12/10)

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.


Your full legal name:
I am the:

Address to be kept confidential:
Address:
City:
State:
Zip:
Phone (area code and number):


IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR  COUNTY, FLORIDA

,
,
,
Petitioner,

and

.
Respondent.


REQUEST FOR CONFIDENTIAL FILING OF ADDRESS


I, , request that the Court maintain and hold as confidential, the following address:
Address:
City, State Zip: , FL   
Phone:

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.



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