Request for Public Records Exemption of Personal Information

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Tampa Police Department (TPD) Request for Exemption/Redaction of Public Records Containing Personal Information of Specified Persons

Important Instructions:

This is a request for redaction of personal information for specified persons from TPD public records in accordance with section 119.071(4)(d)2., Florida Statutes.
Submission of this Request form is only necessary if TPD has public records identifying you or your spouse/child/dependent, and the persons requesting the exemption/redaction qualify as specified persons, under s. 119.071(4)(d), F.S.
Please include the s. 119.071(4)(d)2, subsection that applies to your occupation exemption.
Please submit a separate form for each individual to whom an exemption applies (e.g., your spouse/child/dependent).
A new Request for Exemption/Redaction form must be submitted if there is a change in your information or status as an individual qualifying for an exemption.
This form is for Law Enforcement occupations, Law Enforcement adjacent occupations, and family members of those employed in these fields. Please see Florida Statute 119.071(4)(d)2 to determine if you qualify.

First (Required)

Middle

Last (Required)

Suffix

Date of Birth

Address

City (Required)

State (Required)

ZIP Code (Required)

Email Address

Phone Number:

Qualifying employment for exemption/redaction of personal information (Required):

Name of Qualiying Current or Former Employing Agency (Required):

Specific subsection that qualifies for Your Request FS 119.071(4)(d)2: (Required)

Attestation

Attestations:

I hereby swear or affirm to the following: I have reviewed the appropriate section(s) of law listed above. I am an individual, or the parent/guardian of an individual, exempt pursuant to the public records exemption(s) indicated above. All information on this form is true and correct. Where applicable, I have made reasonable efforts to protect such information from being accessible through other means available to the public.

signature

Sign above (Required)

Print Your Full Name (Required):

Date (Required)

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