PREIS | Exemption Request

Personal Information

First Name *

Middle Name

Last Name *

Prefix

Suffix

Other Names or Aliases(Maiden Name, Prior Legal Name)

Email Address *

Date Of Birth *

Address Information

Address Type *

Address *

Address Line 2

City *

State *

ZIP *

Phone Number Information

Phone Type

Phone Number

FWC Identifier

FWC Identifier Type

FWC Identifier

Florida Statutes ( Click here to view Florida Statutes )

Florida Statute – Authority for Exemption *

Attestation *

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.

Agree Disagree

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