"Request for Release of Juvenile Records" - Florida

Request for Release of Juvenile Records is a legal document that was released by the Florida Department of Juvenile Justice - a government authority operating within Florida.

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FLORIDA DEPARTMENT OF JUVENILE JUSTICE
Rick Scott, Governor
Christina K. Daly, Secretary
Request For Release Of Juvenile Records
(Please Print)
This request may be subject to service charges. Please see Florida Statute Section 119.07(4)(d), F.S. regarding the
application of this fee. This office may request a deposit prior to production of this request.
I, ______________________________, hereby authorize the Florida Department of Juvenile
Justice by its agents or authorized representative, to provide ____________________________
with the following records regarding: _________________________________ date of birth
Youth Name
__________________________________.
Youth Date of Birth
Please Check One
Complete Records File
____
____ Face Sheet (RAP Sheet) Only
____ Medical Records Only
igned_______________________________
S
Self/Parent/Guardian
Email:_______________________________
Phone:_______________________________
Fax:_________________________________
Address:_____________________________
____________________________________
STATE OF ___________________
COUNTY OF_________________
On this _____day of ________________, 20____, before me, the undersigned authority, personally
appeared ________________________, whose name is subscribed hereon, and who executed same
under oath for the purposes herein expressed.
__________________________________________
Notary Public
__________________________________________
Print Name of Notary Public
___ Personally Known To Me
My Commission Expires:_____________________
___ Produced Identification
Type:____________________
Save As
Reset/Clear Form
Print Form
2737 Centerview Drive
Tallahassee, Florida 32399-3100
(850) 488-1850
http://www.djj.state.fl.us
The mission of the Department of Juvenile Justice is to increase public safety by reducing juvenile delinquency through effective
prevention, intervention, and treatment services that strengthen families and turn around the lives of troubled youth.
FLORIDA DEPARTMENT OF JUVENILE JUSTICE
Rick Scott, Governor
Christina K. Daly, Secretary
Request For Release Of Juvenile Records
(Please Print)
This request may be subject to service charges. Please see Florida Statute Section 119.07(4)(d), F.S. regarding the
application of this fee. This office may request a deposit prior to production of this request.
I, ______________________________, hereby authorize the Florida Department of Juvenile
Justice by its agents or authorized representative, to provide ____________________________
with the following records regarding: _________________________________ date of birth
Youth Name
__________________________________.
Youth Date of Birth
Please Check One
Complete Records File
____
____ Face Sheet (RAP Sheet) Only
____ Medical Records Only
igned_______________________________
S
Self/Parent/Guardian
Email:_______________________________
Phone:_______________________________
Fax:_________________________________
Address:_____________________________
____________________________________
STATE OF ___________________
COUNTY OF_________________
On this _____day of ________________, 20____, before me, the undersigned authority, personally
appeared ________________________, whose name is subscribed hereon, and who executed same
under oath for the purposes herein expressed.
__________________________________________
Notary Public
__________________________________________
Print Name of Notary Public
___ Personally Known To Me
My Commission Expires:_____________________
___ Produced Identification
Type:____________________
Save As
Reset/Clear Form
Print Form
2737 Centerview Drive
Tallahassee, Florida 32399-3100
(850) 488-1850
http://www.djj.state.fl.us
The mission of the Department of Juvenile Justice is to increase public safety by reducing juvenile delinquency through effective
prevention, intervention, and treatment services that strengthen families and turn around the lives of troubled youth.