SPUFI REQUEST FORM
Central Registry Sealing of Records Request Form
This form is to be used to request a record be sealed from the DCFS Central Registry database.
✓ Only a supervisor may submit this request.
✓ Email your request to Jill Marano at jmarano@dcfs. your approved request
✓ Please be thorough in your request and include such items as case name, case number etc. The more complete your information the more quickly your request may be processed.
|Supervisor Name (Print and Sign): |
|Clark County DFS Washoe County DSS DCFS Rural Region |
| |
|Date: |Phone # |
|Is this request in response to a court order or hearing officer’s recommendation? |
|Yes No |
|Please provide the name and number of person/case/provider who is requesting their record be sealed: |
| |
| |
|In a brief description, please enter why this record is to be sealed. |
|It has reached the time limitations (10 years after the child’s 18th birthday) |
|It has been appealed and approved for sealing by the child welfare agency. |
|Additional information: |
| |
FIELDS BELOW ARE FOR IMS HELP DESK USE ONLY:
|Additional notes or instruction to the programmers: (For IMS Help Desk Use Only) |
|Heat Ticket #: |Approved/Denied by: |
| | |
|Date: |Date: |
Approved Denied
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