INTEROFFICE MEMORANDUM - Florida Department of Health
Public Records Exemption
Name (please print) Date
I am an emergency medical technician (EMT) or paramedic certified in compliance with Chapter 401, Florida Statutes.
I am a firefighter certified in compliance with section 633.35, Florida Statutes.
I qualify under another exemption from the Public Records laws. Identify the exemption and your basis for qualification for the exemption:
Your basis for qualification for the exemption
Signature Date
Exemption from public records: Your responses in filling out this form are a public record. That means that anyone can request a copy of your completed application form. However we will not supply the following to the requestor:
• Your social security number;
• If you are an EMT or paramedic certified in compliance with chapter 401. Florida Statutes, your home address, telephone number, date or birth and photographs are exempt from s. 119.07(1) and s. 24(a), Florida Statutes.
• If you are a firefighter, certified in compliance s. 633.35, Florida Statute, your home address, telephone number, date of birth and photographs are exempt from s. 119.07(1) and s. 24(a), Florida Statutes.
There are similar exemptions for law enforcement, judges and others. More importantly we will not know you have an exemption unless you tell us. If you have questions about this, please review Chapter 119.07, F.S., and, in particular, subsection 4 [§119.07(4), F.S.].
Please send this completed form to the Certification Office at 4052 Bald Cypress Way, Bin-C85, Tallahassee, Florida 32399-3252.
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