Marsy’s Law FL Constitution, Article 1, §16(b) Victim’s Right to Confidentiality Form

2. Florida Constitution, Article 1, Section 16(b)(5):

   Every victim is entitled to the following right, beginning at the time of his or her victimization: “The right to prevent disclosure of information or records that could be used to locate or harass the victim or the victim’s family, or which could disclose confidential or privileged information of the victim.”

   Every victim is entitled to the following right, beginning at the time of his or her victimization: “The right to prevent disclosure of information or records that could be used to locate or harass the victim or the victim’s family, or which could disclose confidential or privileged information of the victim.”

4. Case Number*

6. I,*

   , as the victim and as my right, do hereby

8. (Please select one)*

   1. Elect
   2. Do Not Elect (I do not want my information to become public record.)

10. to have the Aventura Police Department disclose information or records that could be used to locate or harass me or my family, or which could disclose confidential or privileged information related to me.

    to have the Aventura Police Department disclose information or records that could be used to locate or harass me or my family, or which could disclose confidential or privileged information related to me.

12. I HAVE READ AND UNDERSTOOD THE ABOVE PARAGRAPH. I HAVE BEEN INFORMED OF MY RIGHT UNDER THE CONSTITUTIONAL PROVISION REFERENCED ABOVE.

    I HAVE READ AND UNDERSTOOD THE ABOVE PARAGRAPH. I HAVE BEEN INFORMED OF MY RIGHT UNDER THE CONSTITUTIONAL PROVISION REFERENCED ABOVE.

14. Victim's Signature*

    (If the victim is under age 18, a parent or guardian’s signature should be obtained.)

15. Date*
    Date

19. On Behalf of the Victim

21. Parent/Guardian Name

23. Parent/Guardian Signature

24. Date
    Date

26. Name of Next of Kin of Homicide Victim

    (if applicable)

28. Next of Kin Signature

29. Date
    Date

Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field