Notice Of Confidential Information Within Court Filing {CIT-NCI}

FOURTH IN THE _________ COURT, ____________ JUDICIAL CIRCUIT, IN AND CLAY FOR______________ COUNTY, FLORIDA CASE NO.: Plaintiff/Petitioner, v. Defendant/Respondent. / NOTICE OF CONFIDENTIAL INFORMATION WITHIN COURT FILING Pursuant to Florida Rule of Judicial Administration 2.420(d)(2), the filer of a court record at the time of filing shall indicate whether any confidential information is included within the document being filed; identify the confidentiality provision that applies to the identified information; and identify the precise location of the confidential information within the document being filed. Title/Type of Document(s): Indicate the applicable confidentiality provision(s) below from Rule 2.420(d)(1)(B), by specifying the location within the document on the space provided: Chapter 39 records relating to dependency matters, termination of parental rights, guardians ad litem, child abuse, neglect, and abandonment. § 39.0132(3), Fla. Stat. (If the document is filed within a Chapter 39 case, this form is not required.) Precise Location: Page # Adoption records. § 63.162, Fla. Stat. (If the document is filed within a Chapter 63 adoption case, this form is not required.) Precise Location: Page # Social Security, bank account, charge, debit, and credit card numbers in court records. § 119.0714(1)(i)­(j), (2)(a)­(e), Fla. Stat. (Unless redaction is requested pursuant to § 119.0714(2), this information is exempt only as of January 1, 2011.) Precise Location: Page # HIV test results and patient identity within the HIV test results. § 381.004(3)(e), Fla. Stat. Precise Location: Page # Sexually transmitted diseases -- test results and identity within the test results when provided by the Department of Health or the department's authorized representative. § 384.29, Fla. Stat. Precise Locaiton: Page # Birth and death certificates, including court-issued delayed birth certificates and fetal death certificates. §§ 382.008(6), 382.025(1)(a), Fla. Stat. Precise Location: Page # Identifying information in petition by minor for waiver of parental notice when seeking to terminate pregnancy. § 390.01116, Fla. Stat. (If the document is filed within a Ch. 390 waiver of parental notice case, this form is not required.) Precise Location: Page # Identifying information in clinical mental health records under the Baker Act. §394.4615(7), Fla. Stat. Precise Location: Page # Records of substance abuse service providers which pertain to the identity, diagnosis, and prognosis American LegalNet, Inc. www.FormsWorkFlow.com of and service provision to individuals who have received services from substance abuse service providers. § 397.501(7), Fla. Stat. Precise Location: Page # Identifying information in clinical records of detained criminal defendants found incompetent to proceed or acquitted by reason of insanity. § 916.107(8), Fla. Stat. Precise Location: Page # Estate inventories and accountings. § 733.604(1), Fla. Stat. Precise Location: Page # Victim's address in domestic violence action on petitioner's request. § 741.30(3)(b), Fla. Stat. Precise Location: Page # Information identifying victims of sexual offenses, including child sexual abuse. §§ 119.071(2)(h), 119.0714(1)(h), Fla. Stat. Precise Location: Page # Gestational surrogacy records. § 742.16(9), Fla. Stat. Precise Location: Page # Guardianship reports and orders appointing court monitors in guardianship cases. §§ 744.1076, 744.3701, Fla. Stat. Precise Location: Page # Grand jury records. Ch. 905, Fla. Stat. (If the document is filed in a Ch. 905 grand jury proceeding, this form is not required.) Precise Location: Page # Information acquired by courts and law enforcement regarding family services for children. § 984.06(3)­(4), Fla. Stat. (If the document is filed in a Ch. 984 family services for children case, this form is not required.) Precise Location: Page # Juvenile delinquency records. §§ 985.04(1), 985.045(2), Fla. Stat. (If the document is filed in a Ch. 985 juvenile delinquency case, this form is not required.) Precise Location: Page # Information disclosing the identity of persons subject to tuberculosis proceedings and records of the Department of Health in suspected tuberculosis cases. §§ 392.545, 392.65, Fla. Stat. Precise Location: Page # CERTIFICATE OF SERVICE I HEREBY CERTIFY that a copy of the foregoing was furnished by U.S. mail / personal service to: ,on , 20 . Name ........................................ Address .................................. Phone .................................... Florida Bar No. ......................... Note: The clerk of court shall review filings identified as containing confidential information to determine whether the information is facially subject to confidentiality under the identified provision. The clerk shall notify the filer in writing within 5 days if the clerk determines that the information is NOT subject to confidentiality, and the records shall not be held as confidential for more than 10 days, unless a motion is filed pursuant to subdivision (d)(3) of the Rule. Fla. R. Jud. Admin. 2.420(d)(2). American LegalNet, Inc. www.FormsWorkFlow.com