Protected Information Disclosure {Form 211}

Rule 17.200--Form 211: Protected Information Disclosure It is the responsibility of counsel, if any, and the parties to ensure that protected information is omitted or redacted from documents or exhibits filed with the court. The clerk of court will not review filings to determine whether the required omissions or redactions have been made. For electronic filers, see Division VI of chapter 16 of the Iowa Court Rules. For paper filers, see Iowa Rule of Civil Procedure 1.422. Use this form to identify the full version of any protected information redacted in other documents you have filed. If filing electronically: · Petitioner must complete this form (211) and file it with the Petition (201) and Original Notice (204). · Respondent must complete this form if adding or correcting protected information. Paper filers also may use form 211 to assist in complying with Iowa Rule of Civil Procedure 1.422. If you do not understand how to use this form, or if you should use this form, talk to an attorney. In the Iowa District Court for County where the case is filed County Upon the Petition of Equity case no. Protected Information Disclosure Petitioner Full name: first, middle, last and concerning Respondent Full name: first, middle, last For electronic filers: When protected information, as defined in Iowa Court Rule 16.602, is required by law to be included or is material to the case and must be included in non-confidential documents, a party shall include the protected information on this form. For an explanation of a filer's responsibility and the procedures to use for protecting personal information, refer to Iowa Court Rules: Chapter 16, Rules Pertaining to the Use of the Electronic Document Management System, Division VI, Protection of Personal Privacy. Rule 16.602 provides the list of protected information. Rule 16.604 provides a list of information that may be redacted. 1. Petitioner The spouse who filed for divorce. Provide the complete version of protected information and the redacted version included in documents you file. Name First Middle Last Protected Information Type A. Social security number B. Financial account numbers Complete Information (See Rules 16.602 and 16.604) Redacted Information (See Rule 16.605) - Last four digits only XXX-XX-XXXX Full account number Partial account number only C. Date of birth D. Individual taxpayer identification numbers / mm/dd/yyyy - / Year only Last four digits only XXX-XX-XXXX December 2013 Rule 17.200--Form 211 Page 1 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Rule 17.200--Form 211: Protected Information Disclosure, continued E. Personal identification numbers Full number Partial only F. Other unique identifying numbers Full number Partial only G. Additional protected information Full information Partial information H. Additional protected information Full information Partial information I. Additional protected information Full information Partial information J. Additional protected information Full information Partial information Check this box if you are attaching a separate sheet listing additional information for Petitioner. 2. Respondent The spouse who did not file for divorce. Provide the complete version of protected information and the redacted version included in documents you file. If Petitioner is filling out this form, provide as much information about Respondent as you can. Name First Middle Last Protected Information Type A. Social security number B. Financial account numbers C. Date of birth D. Individual taxpayer identification numbers E. Personal identification numbers Complete Information (See Rules 16.602 and 16.604) Redacted Information (See Rule 16.605) - Last four digits only Partial account number only Year only Last four digits only XXX-XX-XXXX Full account number / mm/dd/yyyy XXX-XX-XXXX / Full number Partial only F. Other unique identifying numbers Full number Partial only G. Additional protected information Full information Partial information H. Additional protected information Full information Partial information I. Additional protected information Full information Partial information J. Additional protected information Full information Partial information Check this box if you are attaching a separate sheet listing additional information for Respondent. December 2013 Rule 17.200--Form 211 Page 2 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Rule 17.200--Form 211: Protected Information Disclosure, continued 3. Other Parties Provide the complete version of protected information and the redacted version included in documents you file. Provide as much information about other parties as you can. Name First Middle Last Protected Information Type A. Social security number B. Financial account numbers Complete Information (See Rules 16.602 and 16.604) Redacted Information (See Rule 16.605) - Last four digits only XXX-XX-XXXX Full account number Partial account number only C. Date of birth D. Individual taxpayer identification numbers E. Personal identification numbers / mm/dd/yyyy - / Year only Last four digits only XXX-XX-XXXX Full number Partial only F. Other unique identifying numbers Full number Partial only G. Additional protected information Full information Partial information H. Additional protected information Full information Partial information I. Additional protected information Full information Partial information J. Additional protected information Full information Partial information Check this box if you are attaching a separate sheet listing additional information for other parties. 4. Children Provide the complete version of protected information and the redacted version included in documents you file. A. Protected Information Type (1) Child's full name Complete Information (See Rules 16.602 and 16.604) Redacted Information (See Rule 16.605) First, middle, last name Child's initials (2) Social security number (3) Date of birth - Last four digits only XXX-XX-XXXX / mm/dd/yyyy / Year only December 2013 Rule 17.200--Form 211 Page 3 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Rule 17.200--Form 211: Protected Information Disclosure, continued B. Protected Information Type (1) Child's full name Complete Information (See Rules 16.602 and 16.604) Redacted Information (See Rule 16.605) First, middle, last name Child's initials (2) Social security number (3) Date of birth - Last four digits only XXX-XX-XXXX / mm/dd/yyyy / Year only C. Protected Information Type (1) Child's full name