PAM CHILDERS
CLERK OF THE CIRCUIT COURT
ESCAMBIA COUNTY, FLORIDA
(FAX) 850-595-4827
Request Form for Removal of Social Security/Bank Account Number from Court Case File or
Publicly Available Internet Website
Pursuant to Section 119.07, F.S.
Date:
Name of Holder of Social Security/Bank Account Number:
Phone Number
Email Address
Relationship to Requester:
Self  
Attorney, specify
Legal guardian, specify
For Redaction/Removal of Social Security ° Bank Account ° Debit ° Charge ° Credit Card Numbers from Court Case File, please specify
Case Number Document Name Page Number
For Redaction/Removal of Social Security ° Bank Account ° Debit ° Charge ° Credit Card Numbers from an Official Record Image on a Publicly Available Internet website, please provide:
Instrument Number Official Records Book/Page Document Type
Signature: