Affidavit To Restrict Public Access To Address And Telephone Numbers (Person Protected Or Injunction) {AOC CRDPO1F}

AFFIDAVIT IN SUPPORT OF APPLICATION TO RESTRICT PUBLIC ACCESS TO ADDRESS AND TELEPHONE NUMBERS IN SPECIFIED PUBLIC RECORDS PURSUANT TO A.R.S. §§11-483, 11-484, 16-153, AND/OR 28-454 FOR USE ONLY BY PERSONS PROTECTED BY AN ORDER OF PROTECTION OR INJUNCTION AGAINST HARASSMENT PLEASE READ THE INSTRUCTIONS BEFORE COMPLETING THIS FORM AND PRINT ALL REQUIRED INFORMATION IN BLACK INK 1. I, _________________________________________________________________, make the Full legal name following statements under oath: 2. I submit this affidavit pursuant to (check only the types of records you are seeking to protect): [ ] (For County Recorder records) A.R.S. §§11-483, and request that the court order sealed for five years my residential address and phone number appearing in instruments and writings recorded by the County Recorder and the unique identifiers and recording dates contained in indexes of recorded instruments maintained by the County Recorder. [ ] (For County Assessor records) A.R.S. §§11-484, and request that the court order sealed for five years my residential address and phone number appearing in instruments, writings and information maintained by the County Assessor. [ ] (For County Treasurer records) A.R.S. §§11-484, and request that the court order sealed for five years my residential address and phone number appearing in instruments, writings and information maintained by the County Treasurer. [ ] (For voter registration records) A.R.S. §16-153, and request that the court order sealed for five years my residential address and phone number and voting precinct number and those of any individuals identified in item 10 that appear in voter registration records. [ ] (For Motor Vehicle Division records) A.R.S. §28-454, and request that the court order sealed my residential address and phone number and those of any individuals identified in item 12 that appear in Motor Vehicle Division records. I understand that the order to seal MVD records has no automatic expiration. 3. I am a person protected by an order of protection or injunction against harassment. In support of my claim, I have attached to this affidavit a true and correct copy of the order of protection or injunction against harassment naming me as a protected person. Arizona Supreme Court Affidavit for use by protected persons Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com AOC CRDPO1F-091907 4. I believe that my life or safety or that of my family or other persons living at my primary residence is in danger of physical harm for the following reasons: ______________________________________________________________________________ ______________________________________________________________________________ 5. (Optional ­ complete this item ONLY if you need immediate record protection) I request immediate action for the following reasons: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ 6. Restricting public access to the records I selected in item 2 above will serve to reduce the danger I described in item 4 for the following reasons: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 7. My primary residential address and telephone number are: _______________________________________________________________________________ Street Address City State ZIP Phone Number 8. (For County Recorder, Assessor and/or Treasurer records only) The identifying numbers relating to my primary residential address are: Parcel Number: __________________________ Book & Map Number:___________________ Full Legal Description: __________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Arizona Supreme Court Affidavit for use by protected persons Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com AOC CRDPO1F-091907 9. (For County Recorder, Assessor and/or Treasurer records only) The document locator number and date of recordation of each document for which I request public access restriction pursuant to A.R.S. §§11-483 and/or 11-484 are as follows. I have attached a copy of pages from each document that show the document locator number, and either my full legal name and primary residential address or my full legal name and telephone number: _____________________________________________________________________ Document locator number Date of recordation ______________________________________________________________________________________________ Document locator number Date of recordation ______________________________________________________________________________________ Document locator number Date of recordation _______________________________________________________________________________________ Document locator number Date of recordation _______________________________________________________________________________________ Document locator number Date of recordation ______________________________________________________________________________________ Document locator number Date of recordation 10. (For voter registration records only -- see the instruction sheet for more information) The following are the names and birth dates for each registered voter who resides with me and whose voter registration records should also be redacted. I have informed these individuals that I have applied to have their addresses protected and that they will need to vote by mail in the future in order to keep this information out of the public record. I have also informed them that if they vote inperson at a polling location, they will be required to vote a provisional ballot. I have checked the box for each voter who is requesting to be added to the Permanent Early Voting List (PEVL) to automatically receive an ea