REQUEST FOR REDACTION OF PERSONALLY IDENTIFYING INFORMATION FROM ELECTRONIC DATABASES
1. Full name of individual whose personally identifying information will be redacted as it appears on the document:
2. Name of person making the request if different than above:
3. If not the individual whose personally identifying information will be redacted, identify the legal relationship that entitles you to make the request: (check one)
a. Surviving spouse
b. Attorney-in-fact
c. Court appointed guardian
4. Type of record:
5. Book and page number or other reference identifying where the document is recorded in the County Register's office:
Book No. Page No. or Instrument No.
6. Signature of person making the request:
State of Tennessee
County of
Personally appeared before me, (person duly authorized to take acknowledgments in [ ] county), the within named , with whom I am personally acquainted (or proven to me on the basis of satisfactory evidence) and who acknowledges that such person executed the within instrument for the purpose of making a request of the Register of Deeds of County, Tennessee, to redact personally identifying information from the aforementioned record, excepting microfilm records.
Witness my hand this day of , 20 .
(signature of person taking acknowledgement)
[Space for Seal of Office]