South Orange, MT · Essex County
Certification and Request for Non-Disclosure of MOD IV Data
This form lets eligible property owners in South Orange request redaction of MOD IV data for a property where they or a Protected Person reside.
What this form is
The form is for a property owner requesting that the Township of South Orange Village redact MOD IV data under Daniel’s Law. It asks for the property address and identifying details, the signer’s relationship to a Protected Person, required proof of Protected Person status, and the signer’s certification, signature, and date. The form also includes an approval or denial section for assessor use.
Who needs it
A property owner in South Orange who is a Protected Person or an immediate family member of one may use this form to request redaction.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed and dated without a notary; it mentions proof of Protected Person status but no notarized or sworn attachment, so the signer just signs and dates it.
How to submit this form
- 1
Download The Form
Download the South Orange Certification and Request for Non-Disclosure of MOD IV Data.
- 2
Complete The Form
Enter the property details and Protected Person information, make the required certifications, and sign and date the form.
- 3
Gather Required Proof
Include the required proof of Protected Person status referenced in the form.
- 4
Submit To The City
Submit the completed form to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does the MOD IV data non-disclosure form request?
- It lets a South Orange property owner request redaction of MOD IV data for a property where they or a Protected Person reside.
- Who can request redaction using this form?
- The form identifies active, former, or retired judicial officers, prosecutors, and law enforcement officers, as well as their immediate family members, as eligible categories.
- Do I need a notary for the MOD IV data non-disclosure request?
- No. The document has a signature and date line but no notary block. It asks for required proof of Protected Person status, but does not identify that proof as notarized or sworn.
- How do I submit the MOD IV data non-disclosure request?
- The document does not give submission instructions. Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Certification and Request for Non-Disclosure of MOD IV Data doesn’t need a notary — but if you have another South Orange form that does, a commissioned online notary can help.