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Request Form For Social Security Or Account Number Removal - Florida

Request Form For Social Security Or Account Number Removal Form. This is a Florida form and can be used in Official Records Lake Local County .
 Fillable pdf Last Modified 5/24/2010
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Request Form For Social Security or Account Number* Removal *includes complete bank account, debit, charge, or credit card number Date:________________________ Name of Holder of SSN or Account Number: ________________________________________ Phone Number: (optional)_______________________________________________________ Relationship to Requester: [ ] Self [ ] Attorney, specify [ ] Legal Guardian, specify For Redaction/Removal of SSN or Account Number from an Official Record Image on a Publicly Available Internet website, please provide: Instrument Number/Book and Page Number/Document Type For Redaction/Removal of SSN or Account Number from Court Records, please specify: Case Number/Document Name/Page Number Signature: _____________________________________________________ Date Request Received:________________________ Date Request Completed:_______________________ Clerk Processing Request:______________________Please complete and mail or fax form to: Recording Division, Lake County Clerk of Circuit Court,122 E. Main Street, Post Office Box 7800,Tavares, FL 32778-7800FAX: (352) 253-2616
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