Request To Redact Address

This document is a public record, and the information you provide may be released in response to a public records request. Updated 3/22/2019 REQUEST TO REDACT ADDRESS Instructions : Complete entire form below and send directly to the public office that maintains the records to be redacted. The Ohio Attorney General will not forward requests on behalf of the requesting individual. The Ohio Attorney General is also not required or permitted to review and/or approve a request for redaction. I, , request that the office of (print full name) (print name of public office) redact my address from any record made available to the general public on the internet that includes my residential and familial information. I am currently employed as a (Check the box that applies): Asst. Prosecuting Attorney Bailiff BCI Investigator Correctional Employee Medical Director Prosecuting Attorney Youth Services Employee EMT Firefighter Judge Magistrate Parole Officer Peace Officer Probation Officer Board of Pharmacy Employee County or Multicounty Corrections Officer Community-Based Correctional Facility Employee Member of EMS Cooperating Physician Advisory Board Federal Law Enforcement Officer For each known instance, please identify the location of your address within any record made available by the public office listed above to the public on the internet: Document Title & Description: Specific Web Address (URL): Location of Address within Document: (Use the second page of this form to identify additional locations of address to be redacted) Signature of Requester Date Signed Printed Name of Requester Telephone Number Full Address (Street, City, State, ZIP) Email Address Date Request Received / / (For Public Office Use) American LegalNet, Inc. www.FormsWorkFlow.com Request to Redact Address Page 2 This document is a public record, and the information you provide may be released in response to a public records request. Updated 3/22/2019 Document Title & Description: Specific Web Address (URL): Location of Address within Document: Document Title & Description:Specific Web Address (URL):Location of Address within Document: Document Title & Description: Specific Web Address (URL): Location of Address within Document: Document Title & Description: Specific Web Address (URL): Location of Address within Document: Document Title & Description: Specific Web Address (URL): Location of Address within Document: American LegalNet, Inc. www.FormsWorkFlow.com