Form HSMV 96020 Request to Withhold Personal Information - Florida

Form HSMV96020 is a Florida Department of Highway Safety and Motor Vehicles form also known as the "Request To Withhold Personal Information". The latest edition of the form was released in June 1, 2018 and is available for digital filing.

Download an up-to-date Form HSMV96020 in PDF-format down below or look it up on the Florida Department of Highway Safety and Motor Vehicles Forms website.

ADVERTISEMENT
PUBLIC OFFICIAL, LAW ENFORCEMENT AGENCY PERSONNEL AND OTHERS
PURSUANT TO SECTION 119.071, FLORIDA STATUTES
REQUEST TO WITHHOLD PERSONAL INFORMATION
This request form and corresponding privacy protection applies to current and former sworn or civilian law enforcement
personnel, public officials (active or former), servicemembers (active or former after 09/11/2001) and other identified
individuals, their spouses, children or dependents, who are eligible as outlined in Section 119.071, Florida Statutes. Those
who are eligible can request that the Department of Highway Safety and Motor Vehicles (DHSMV) withhold personal
information contained in their driver/identification, vehicle/vessel records maintained by this department. This privacy
protection does not apply to the mailing addresses maintained by this department. Mailing addresses may be released
for official business regarding motor vehicle or driver license information. Therefore, if you wish to ensure your
residential address is blocked and not displayed on your driver license/identification card, you may make an
appointment with your local driver license issuance office to provide an alternate mailing address and obtain a
replacement driver license/identification card.
The completion of this form is not mandatory but is made available as a convenience to individuals making this request and
to ensure that DHSMV has necessary information to update the appropriate records.
Please PRINT the personal information requested below. The information required to complete this form is located on the
Florida driver license or identification card of the requester. In all cases, the date of birth must match the date of birth on the
Florida driver license or identification card record. Complete additional forms or attach additional sheet as needed to include
eligible family members. We must have a statement of eligibility and documentation that indicates the eligibility.
Please return your request with documentation that indicates your eligibility to: Department of Highway Safety and
Motor Vehicles (DHSMV), 2900 Apalachee Parkway, MS 28, Tallahassee, Florida 32399 or email to
PublicOfficialBlock@flhsmv.gov
Personal Information of Individual Submitting Request
______________________________________________________________________________________________________________
FIRST NAME
MIDDLE NAME
LAST NAME
______________________________________________________________________________________________________________
STREET ADDRESS
CITY
STATE & ZIP CODE
Florida Driver License/Identification Card Number
Date of Birth
Family Member(s) Driver License or Identification Card Information (spouse/child)
1.
Florida Driver License/Identification Card Number
Date of Birth
2.
Florida Driver License/Identification Card Number
Date of Birth
3.
Florida Driver License/Identification Card Number
Date of Birth
Note: See second page for a list of those who are eligible.
HSMV 96020 (Rev. 6/18)
PUBLIC OFFICIAL, LAW ENFORCEMENT AGENCY PERSONNEL AND OTHERS
PURSUANT TO SECTION 119.071, FLORIDA STATUTES
REQUEST TO WITHHOLD PERSONAL INFORMATION
This request form and corresponding privacy protection applies to current and former sworn or civilian law enforcement
personnel, public officials (active or former), servicemembers (active or former after 09/11/2001) and other identified
individuals, their spouses, children or dependents, who are eligible as outlined in Section 119.071, Florida Statutes. Those
who are eligible can request that the Department of Highway Safety and Motor Vehicles (DHSMV) withhold personal
information contained in their driver/identification, vehicle/vessel records maintained by this department. This privacy
protection does not apply to the mailing addresses maintained by this department. Mailing addresses may be released
for official business regarding motor vehicle or driver license information. Therefore, if you wish to ensure your
residential address is blocked and not displayed on your driver license/identification card, you may make an
appointment with your local driver license issuance office to provide an alternate mailing address and obtain a
replacement driver license/identification card.
The completion of this form is not mandatory but is made available as a convenience to individuals making this request and
to ensure that DHSMV has necessary information to update the appropriate records.
Please PRINT the personal information requested below. The information required to complete this form is located on the
Florida driver license or identification card of the requester. In all cases, the date of birth must match the date of birth on the
Florida driver license or identification card record. Complete additional forms or attach additional sheet as needed to include
eligible family members. We must have a statement of eligibility and documentation that indicates the eligibility.
Please return your request with documentation that indicates your eligibility to: Department of Highway Safety and
Motor Vehicles (DHSMV), 2900 Apalachee Parkway, MS 28, Tallahassee, Florida 32399 or email to
PublicOfficialBlock@flhsmv.gov
Personal Information of Individual Submitting Request
______________________________________________________________________________________________________________
FIRST NAME
MIDDLE NAME
LAST NAME
______________________________________________________________________________________________________________
STREET ADDRESS
CITY
STATE & ZIP CODE
Florida Driver License/Identification Card Number
Date of Birth
Family Member(s) Driver License or Identification Card Information (spouse/child)
1.
Florida Driver License/Identification Card Number
Date of Birth
2.
Florida Driver License/Identification Card Number
Date of Birth
3.
Florida Driver License/Identification Card Number
Date of Birth
Note: See second page for a list of those who are eligible.
HSMV 96020 (Rev. 6/18)
Please refer to section 119.071, Florida Statutes for specific information regarding each exemption.
Current or former sworn or civilian law enforcement personnel
Current or former Correctional and correctional probation officers
Current or former personnel of the Department of Children and Family Services who investigate cases of abuse,
neglect, exploitation, fraud, theft, or other criminal activities
Current or former personnel of the Department of Health whose duties are to support the investigation of child abuse
or neglect
Current or former personnel of the Department of Revenue or local governments whose responsibilities include revenue
collection and enforcement or child support enforcement
Current or former certified firefighters
Current or former justices of the Supreme Court, district court of appeal judges, circuit court judges, and county court
judges
Current or former state attorneys, assistant state attorneys, statewide prosecutors, and assistant statewide prosecutors
Current or former human resource, labor relations, or employee relations directors, assistant directors, managers, or
Assistant managers of any local government agency or water management district whose duties include hiring and firing
employees, labor contract negotiation, administration, or other personnel-related duties
Current or former United States attorneys and assistant United States attorneys
Current or former United States Courts of Appeal judges, United States district judges, United States magistrate judges
Current or former code enforcement officers
Current or former guardian ad litem, as defined in s. 39.820
Current or former juvenile probation officers, juvenile probation supervisors, detention superintendents, assistant
detention superintendents, juvenile detention officers, senior juvenile detention officers, juvenile detention officer
supervisors, house parents I and II, house parent supervisors, group treatment leaders, group treatment leader
supervisors, rehabilitation therapists, and social service counselors of the Department of Juvenile Justice
Current or former public defenders, assistant public defenders, criminal conflict and civil regional counsel, and assistant
criminal conflict and assistant regional counsel
Current or former county tax collectors
Current or former servicemembers, who served after September 11, 2001
Current or former impaired practitioner consultants retained by an agency or certain current or former employees of an
impaired practitioner consultant, under specified circumstances
Current or former non-sworn investigative personnel of the Department of Financial Services
Current or former emergency medical technicians or paramedics certified under chapter 401, F.S.
Current or former employees of an agency’s office of inspector general or internal audit department whose duties
include auditing or investigation of waste, fraud, abuse, theft, exploitation, or other activities that could lead to criminal
prosecution or administrative discipline
Current or former non-sworn investigative personnel of the Office of Financial Regulations Bureau of Financial Investigations whose duties include
the investigation of fraud, theft, or other related criminal activities, or state regulatory requirement violations
Current or former directors, managers, supervisors, and clinical employees of a Child Advocacy Center (CAC) and Child Protection Team (CPT)
Current or former public guardians and employees with fiduciary responsibility, as defined in s. 744.21031, F.S.
Current or former directors, managers, supervisors, nurses, and clinical employees of government owned addiction treatment facilities
HSMV 96020 (Rev. 6/18)

Download Form HSMV 96020 Request to Withhold Personal Information - Florida

287 times
Rate
4.6(4.6 / 5) 20 votes
ADVERTISEMENT
Page of 2