Edit Form Receipt for Victim's Rights Webpage Today's Date* Case Number* Legal Name* I have reviewed the Victims' Rights Webpage in it's entirety. The name & date above certifies my electronic signature.* Yes Which officer directed you to review this page?* Officer I.D.#* Exemption From Public Records Disclosure As the victim of a crime, you may request an exemption PROHIBITING disclosure of information or records to the general public that could be used to locate or harass you or your family or which could disclose confidential or privileged information. (CONSTITUTION OF THE STATE OF FLORIDA, Article 1, Declaration of Rights of Victims, Section 16, Paragraph (b)(5) - "Marsy’s Law"). Do you wish to exercise this right?* Yes No Electronic Signature*? Date*
