FLHSMV Personal Information Withhold Request
The file is a formal request form for current and former sworn or civilian law enforcement personnel, public officials, and their families to withhold personal information. It applies to various records maintained by the Florida Highway Safety and Motor Vehicles department. The form is to be submitted with supporting documentation for eligibility and exemption.
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How do I fill this out?
To fill out this form, you will need to provide personal information, including your name, date of birth, and driver’s license number. You’ll also need to fill in details for any family members you wish to include. Lastly, you must affirm your eligibility and get the form notarized.
How to fill out the FLHSMV Personal Information Withhold Request?
1
Fill out your personal information including name, date of birth, and driver’s license number.
2
Provide details for any eligible family members.
3
Affirm your eligibility under penalty of perjury.
4
Get the form notarized with your signature and identification.
5
Submit the form along with the required documentation to FLHSMV.
Who needs the FLHSMV Personal Information Withhold Request?
1
Current or former sworn or civilian law enforcement personnel who want to keep their personal information private.
2
Public officials and their families who need to withhold residential addresses from public records.
3
Employees of government or judicial agencies who are eligible under Section 119.071 and 744.21031, Florida Statutes.
4
Certified firefighters looking for privacy protection for their personal information.
5
Directors, managers, supervisors, and clinical employees of government addiction treatment facilities.
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Editing your PDF on PrintFriendly is simple and efficient. Use our PDF editor to input all necessary information and make corrections as needed. Ensure all sections are accurately filled before finalizing your submission.
1
Upload the PDF file onto PrintFriendly’s platform.
2
Use the PDF editor to fill in your personal and family member details.
3
Verify your eligibility and fill out the affirmation section.
4
Ensure the form is notarized with the necessary signatures.
5
Save your edited PDF and submit it as required.
What are the instructions for submitting this form?
Submit this form along with documentation indicating your eligibility to: Florida Highway Safety and Motor Vehicles, 2900 Apalachee Pkwy, Mail Stop 28, Tallahassee, FL 32399. Alternatively, you can email your completed form and supporting documents to PublicOfficialBlock@flhsmv.gov. Ensure all sections are completed accurately and the form is notarized before submission. My advice is to double-check all information and ensure eligibility documentation is included to prevent processing delays.
What are the important dates for this form in 2024 and 2025?
For 2024 and 2025, please ensure to submit your request form by the deadlines specified by the Florida Department of Highway Safety and Motor Vehicles to ensure timely processing.
What is the purpose of this form?
The purpose of this form is to enable eligible individuals to withhold their personal information from public records to protect their privacy and safety. This includes current or former sworn or civilian law enforcement personnel, public officials, and their families, who can request the Florida Highway Safety and Motor Vehicles to withhold residential addresses and other sensitive information. By completing and submitting this form, individuals ensure that their personal information remains confidential and protected from unauthorized access. This measure helps safeguard the privacy and security of those in sensitive positions and their families, reducing risks associated with public exposure of their personal data.
Tell me about this form and its components and fields line-by-line.
- 1. Name as It Appears on Driver License: Enter your full name as it appears on your Florida driver’s license or identification card.
- 2. Date of Birth: Provide your date of birth to match with the records on your Florida driver’s license or identification card.
- 3. FL DL/ID Number: Enter your Florida driver’s license or identification card number for record verification.
- 4. Street Address: Provide your residential street address that needs to be withheld from public records.
- 5. City, State, Zip Code: Enter your city, state, and zip code corresponding to your residential address.
- 6. Statutory Basis for Exemption: Indicate the statutory basis for your exemption eligibility as outlined in Florida Statutes.
- 7. FAMILY MEMBER/MEMBERS (SPOUSE/CHILD) INFORMATION: Provide details including the FL DL/ID Number and date of birth for any eligible family members.
- 8. AFFIRMATION: Under penalty of perjury, affirm your eligibility by signing and getting the form notarized.
- 9. Notary Public Section: This section includes details for the notary public to fill in and confirm the identification produced. It includes the notary public’s name, signature, commission expiration date, and stamp or seal.
What happens if I fail to submit this form?
Failure to submit this form can result in your residential address and personal information being publicly accessible.
- Public Access: Your residential address will be publicly available and may be used for official business regarding motor vehicle or driver license information.
- Lack of Privacy Protection: You and your family will not have the privacy protections offered by the form, making you vulnerable to unauthorized access to your information.
How do I know when to use this form?
- 1. Sworn/Civilian Law Enforcement Personnel: To ensure your residential address and personal data are kept confidential.
- 2. Public Officials: To withhold residential information from public records for safety.
- 3. Certified Firefighters: To protect personal and residential information from public disclosure.
- 4. Government Employees: Eligible government employees seeking to withhold personal information from public records.
- 5. Judicial Employees: Judicial employees who require confidentiality for their personal information.
Frequently Asked Questions
What information do I need to fill out this form?
You need your name, date of birth, driver’s license number, and details of any family members you wish to include.
Can I fill out this form online?
Yes, you can fill out this form online using PrintFriendly’s PDF editor.
Do I need to notarize this form?
Yes, the form must be notarized with your signature and identification.
Where do I submit the completed form?
Submit the form to Florida Highway Safety and Motor Vehicles at 2900 Apalachee Pkwy, Mail Stop 28, Tallahassee, FL 32399 or email it to PublicOfficialBlock@flhsmv.gov.
Who is eligible to submit this form?
Current or former sworn or civilian law enforcement personnel, public officials, and other identified individuals as outlined in Florida Statutes.
How can I share the completed form?
You can share the completed form via email using PrintFriendly or download it for printing and mailing.
What if I make a mistake while filling out the form?
You can use PrintFriendly’s PDF editor to correct any mistakes before finalizing your submission.
Can I include my family members in this request?
Yes, you can include eligible family members by providing their details in the form.
How do I get the form notarized?
You need to appear before a notary public to get the form notarized with your signature and the type of identification produced.
Can I save my progress while filling out the form?
You can save your changes as you fill out the form using PrintFriendly’s editing tools before final submission.
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