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Utility Customer Public Records Exemption Request

  1. I certify that I am covered under the provisions of Florida Statute 119 for the reasons indicated below:
    Law Enforcement Officer, Correctional Officer, or Correctional Probation Officer
    Juvenile Probation Officers, Juvenile Probation Supervisors, Detention Superintendents, Assistant Detention Superintendents, Juvenile Justice Detention Officers I and II, Juvenile Justice Detention Officer Supervisors, Juvenile Justice Residential Officers, Juvenile Justice Residential Officer Supervisors I and II, Juvenile Justice Counselors, Juvenile Justice Counselor Supervisors, human services counselor administrators, senior human services counselor administrators, rehabilitation therapists, and social services counselors of the Department of Juvenile Justice.
    Employee of Department of Children and Family Services whose duties include the investigation of abuse, neglect, exploitation, fraud, theft, or other criminal activities
    Personnel of the Department of Health whose duties are to support the investigation of child abuse or neglect, or result in, the determination or adjudication of eligibility for social security disability benefits, the investigation or prosecution of complaints filed against health care practitioners, or the inspection of health care practitioners or health care facilities licensed by the Department of Health
    Investigators or Inspectors of the Department of Business and Professional Regulation
    Personnel of the Department of Revenue or local governments whose responsibilities include revenue collection and enforcement or child support enforcement
    County Tax Collectors
    Firefighter certified in compliance with s. 633.35, F.S.
    Justice of the Supreme Court, District Court of Appeals Judge, Circuit Court Judge, or County Court Judge
    State Attorney, Assistance State Attorney, Statewide Prosecutor, or Assistance Statewide Prosecutor
    Guardian Ad Litem, as defined in s. 39.820, F.S.
    Public Defenders, Assistant Public Defenders, Criminal Conflict and Civil Regional Counsel, and Assistant Criminal Conflict and Civil Regional Counsel
    Victim of Domestic Violence in compliance with s 741.30 and 741.316, F.S.
    County and Municipal Code Inspector
    Code Enforcement Officer, or Animal Control Officer
    Veteran, as defined in s. 1.01(14), F.S.; in compliance with s. 296.09(1), F.S.
    Human Resources, Labor Relations, or Employee Relations Directors, Assistant Directors, Manager, or Assistant Managers or any local government agency, or Water Management District whose duties include hiring and firing employees, labor contract negotiation, administration, or other personnel-related duties.
  2. By typing my name in this form, I affirm the accuracy of information provided on this application. I understand that this constitutes a legal signature and confirms that I agree to the above terms.
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