UCNSB Records Exemption Request

UCNSB Records Exemption Request

Exemptions below can be found in the Florida Statutes indicated. Claiming an exemption does not mean the entire record is exempt. It means that home addresses, phone numbers, photographs and places of employment
of you and/or your spouse and children, if in the record, may be redacted (blacked out) before the record is released for inspection or copying. In most cases, names will NOT be exempt (the categories in which they will be are noted below). Prior to claiming an exemption, please review the associated Florida Statue to understand your specific exemption(s) you are requesting the U.C. to maintain. Please understand that this form is a public record and if a request is made for this record, exemptions allowed by law would be redacted prior to release.


Pursuant to Section 119.071(4)(d)3., Florida Statutes, I hereby request all information specified in Section 119.071(4)(d)2., and pertaining to me, found in the Utilities Commission, City of New Smyrna Beach’s Official Records be maintained as exempt. In making this request, I attest that I am an individual listed in Section 119.071(4)(d)3. entitled to make such request. Specifically, I am a:


Signature & Agreement
The information provided on this request for exemption is itself to be exempt. The information may only be used by the Utilities Commission in order to process my request for exemption or may be released upon entry of an order from a court of competent jurisdiction. I agree to indemnify and hold harmless the Utilities Commission and its employees for actions or damages that may be the direct or indirect result of my request for exemption and the fulfillment or lack of fulfillment of that request.
Please type your initials below to indicate your agreement with UCNSB Record Exemption Request Form Requirements.