Request of Records Protection

Full Legal Name:

Date of Birth:

Email:

Address:

City:

Zip Code:

Home/Cell Phone:

Voting Precinct:

Additional form required. Please see Clerk/Auditor.

Parcel Number:

I hereby confirm that I am a Law Enforcement Official pursuant to Utah Code Ann. '53-13-103 or a correction officer as defined in Section 53-13-104

I hereby confirm that I am an at risk employee under Utah code 63G-2-303

Show Credentials or Upload:

PIN:

Upload Credentials (Image/PDF):

Residence Ownership

I live at this residence but am not the listed owner

By execution of this application, I understand and agree to the following:

If records are in County offices, I may not receive official notices.
This request applies only to listed documents.
A title researcher may still trace my address.
Each time new documents are recorded, a new application is needed.
I am responsible for monitoring records and filing new applications.
This application remains effective for up to four years or one year after notice of death.
I or my family may rescind this application at any time.

I hereby confirm that the information provided above is accurate and complete to the best of my knowledge.

Signature:

Date: