HomeMy WebLinkAbout03-21-2009 Request for ConfidentialityJoan Brown
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From: Kate Latorre [klatorre@orlandolaw.net]
Sent: Saturday, March 21, 2009 1:31 PM
To: Joan Brown
Subject: Request for Confidentiality
Attachments: Kate Latorre.vcf; REQUEST FOR CONFIDENTIA TY FORM.pdf
Joan,
Pursuant to our conversation last week, I have modified the Request for Confidentiality form to reflect that the City will
require some kind of official documentation in support of the request. The language is underlined and located at the top of
page 1. Please review and advise whether this language meets the City's needs.
Let me know if I can be of further assistance.
Thanks,
Kate
U
Katherine W. Latorre, Esq.
Board Certified in City, County & Local Government Law
111 N. Orange Avenue, Suite 2000
P.O. Box 2873
Orlando, Florida 32802-2873
Phone (407) 425-9566
Fax (407) 425-9596
Kissimmee (321) 402-0144
Cocoa (866) 425-9566
Website: www.orlandolaw.net
Email: klatorre(aD-orlandolaw. net
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CITY OF WINTER SPRINGS
REQUEST FOR CONFIDENTIALITY
While Chapter 119, Florida Statutes, provides that it is the general policy of the state that all state, county, and municipal records are
open for personal inspection and copying by any person, certain personal identifying information of certain agency personnel, their
spouse, and children is explicitly exempt from disclosure as part of the public record. Those individuals who desire to benefit from such
exemption are required to submit a written request for maintenance of the exemption to the Winter Springs City Clerk's Office. Upon
receipt and review of a Request for Confidentiality, the City Clerk shall maintain the exempt status of the personal information with
regard to the City's Official Records. See generally § 119.071, Fla. Stat. (2006).
Please be advised that all persons seeking exemption of personal identifying information from the City public records shall provide
supporting documentation showing such exemption is warranted Documentation may include but is not limited to past or current
Form-W2s pay stubs or any similar official documents supporting this request
(Please print):
Full Name:
Home/Property Address:
Telephone No:
Other names used:
City, State, Zip:
I am a(n): (Please select only one (1) of the following):
Active _ Former
Spouse of an active _ Spouse of a former
Child of an active _ Child of a former
(Please select all that apply):
Law Enforcement Personnel (including correctional and correctional probation officers)
Department of Children & Family Services Personnel (whose duties include the investigation of abuse, neglect,
exploitation, fraud, theft, or other criminal activity)
Department of Health Personnel (whose duties include support and investigation of child abuse or neglect)
Department of Revenue or Local Government Personnel (whose duties include revenue collection and enforcement
or child support enforcement)
Justice or Judge (U.S. Court of Appeal, U.S. District Court, Magistrate)
State Attorney, Assistant State Attorney, Statewide Prosecutor, Assistant Statewide Prosecutor, U.S. Attorney, or
Assistant U.S. Attorney
Water Management District or Local Government Personnel (if employed as Human Resource, Labor Relations or
Employee Relations Director, Assistant Director, Manager or Assistant Manager AND whose duties include hiring and
firing, labor contract negotiation, administration, or other personnel duties)
Code Enforcement Officer
_ Guardian Ad Litem
(if seeking confidentiality as a Guardian Ad Litem, a written statement shall be submitted providing that reasonable
efforts have been made to protect confidential information from being accessible to the public through other means.)
Juvenile Probation Officer or Supervisor; Detention Superintendent, Assistant Detention Superintendent, Senior
Juvenile Detention Officer, Juvenile Detention Officer or Supervisor
Other (Please specify exempt entity: )
OR
City Of Winter Springs • City Hall
1126 East State Road 434 • Winter Springs, FI.32708
Page 1 of 3
(Revised March 2009)
CITY OF WINTER SPRINGS
REQUEST FOR CONFIDENTIALITY
I am a(n): (Please select only one (1) of the following):
Active
Spouse of an active
Child of an active
(Please select all that apply):
Firefighter (as defined by § 633.36, Fla. Stat.)
Justice or Judge (Florida Supreme Court, District Court of Appeal, Circuit or County Court)
Term Expires
Other (Please specify exempt entity:
1 understand that the information provided on this Request For Confidentiality is itself to be kept confidential. The City of Winter
Springs may only use this information in order to process my Request For Confidentiality. I am filing this Request For Confidentiality
with the City of Winter Springs pursuant to section 119.071(4)(d)8., Florida Statutes (2006), as amended, for the exemption of
information located in the City of Winter Springs Official Records and do attest that I am an individual covered under section 119.071,
Florida Statutes as specified herein.
1 understand that the information exempt from the public record includes the home address, telephone numbers, social
security number, and photographs of the individual falling into the various protected category(s) specified herein, as well as the home
addresses, telephone numbers, social security numbers, photographs, and places of employment of the spouses and children of such
individual; and the names and locations of schools and day care facilities attended by the children of such individual.
This Request for Confidentiality shall not be construed as a contractual agreement between the City and the individual
submitting the Request For Confidentiality.
Signed:
State of Florida
County of
Date:
[APPLICANT SHOULD SIGN IN PRESENCE OF NOTARY]
Sworn to or affirmed and subscribed before me this day of
who is _personally known
as identification.
Signed:
of the year by
to me or who has produced
My Commission Expires:
City Of Winter Springs • City Hall
1126 East State Road 434 • Winter springs, FI.32708
Page 2 of 3
(Revised March 2009)
CITY OF WINTER SPRINGS
REQUEST FOR CONFIDENTIALITY
[THIS PAGE TO BE COMPLETED BY CITY CLERK'S OFFICE]
The following documents were presented to the City Clerk's office In support of the request for confidentiality made pursuant
to filing of this form:
2.
3.
4.
5.
Received by:
SEND COMPLETED FORM TO: Andrea Lorenzo-Luaces, City Clerk
City of Winter Springs
1126 E. State Road 434
Winter Springs, FL 32708
Date:
Please note that the signed original of this form must be received by the Clerk's Office. Faxed copies will not be accepted.
City Of Winter Springs • City Hall
1126 East State Road 434 • Winter Springs, FI.32708
Page 3 of 3
(Revised March 2009)