Florida Department of Highway Safety and Motor Vehicles · Florida state form
HSMV-96030 Request to Withhold Personal Information
Use HSMV-96030 to request that FLHSMV withhold eligible personal information for a current congressional member or public officer and qualifying family members.
- What this form is
- HSMV-96030 is a request form for eligible current congressional members and public officers, their spouses, and children seeking to have specified personal information withheld by FLHSMV. The form requests the individual’s identifying details, statutory basis, service dates, and family-member information. The requestor affirms eligibility under penalty of perjury, and the form includes a notary section.
- Who needs it
- Current congressional members and public officers, their spouses, or children who qualify for the privacy exemption may use this form to request withholding.
- Why it needs a notary
- The requestor’s signature must be notarized using the form’s notary section; this can be done online with a commissioned online notary.
- How to submit it
- Submit the completed form with documentation showing eligibility and the statutory basis for the exemption to the address on the form or email it to [email protected].
Questions
Who can use HSMV-96030?
The form is for current congressional members and public officers, their spouses, and children who are eligible for the personal-information exemption described on the form.
How do I submit the request?
Send the completed form with documentation indicating eligibility and the statutory basis for the exemption to the mailing address printed on the form or email it to [email protected].
Does HSMV-96030 need to be notarized?
Yes. The form has a notary section for the requestor’s signature. You can have the signature notarized online with a commissioned online notary.