Request Form for Social Security/Bank Account Number Removal



Request Form for Social Security/Bank Account Number Removal

Date: MAY-17-2008

Name of Holder of Social Security Number:

Email:

Phone: (optional)

Relationship to Requestor:

Self

Attorney, specify

Legal Guardian

Please enter your name if not self.

For Redaction/Removal of Social Security Number from an Official Recod Image on a Publicly Available Internet website, please provide:

Clerk's File Number (ex: 1990 R 100)

Recording Book/Page:

Document Type:

Items to redact/remove:

Social Security Number

Bank Account Number

Credit/Debit Card Number