Delaware Cnty. C.P. CommonPleasAdminOrders_AOD SID 2

Rev. 7/2018 THIS FORM IS CONFIDENTIAL

CONFIDENTIAL

INFORMATION

FORM

Additional page(s) attached. total pages are attached to this filing.

I certify that this filing complies with the provisions of the Case Records Public Access Policy of the Unified

Judicial System of Pennsylvania that require filing confidential information and documents differently than non-confidential information and documents.

Signature of Attorney or Unrepresented Party Date

Name: Attorney Number: (if applicable)

Address: Telephone:

Email:

NOTE: Parties and attorney of record in a case will have access to this Confidential Information

Form. Confidentiality of this information must be maintained.

Rev. 7/2018 THIS FORM IS CONFIDENTIAL

CONFIDENTIAL

INFORMATION

FORM

Additional page (if necessary)

This Information Pertains to: Confidential Information: References in Filing:

Social Security Number (SSN): Alternative Reference:

SSN

(full name of adult)

Financial Account Number (FAN): Alternative Reference:

OR FAN

This information pertains to a

minor with the initials of Driver's License Number (DLN): Alternative Reference:

and the full name of DLN

(full name of minor) State of Issuance:

and date of birth:

State Identification Number (SID): Alternative Reference:

SID

Social Security Number (SSN): Alternative Reference:

SSN

(full name of adult)

Financial Account Number (FAN): Alternative Reference:

OR FAN

This information pertains to a

minor with the initials of Driver's License Number (DLN): Alternative Reference:

and the full name of DLN

(full name of minor) State of Issuance:

and date of birth:

State Identification Number (SID): Alternative Reference:

SID

Rev. 7/2018 THIS FORM IS CONFIDENTIAL

CONFIDENTIAL

INFORMATION

FORM

Instructions for Completing the Confidential Information Form

The following information is confidential and shall not be included in any document filed with a court

or custodian, except on a Confidential Information Form filed contemporaneously with the document:

1. Social Security Numbers

2. Financial Account Numbers, except an active financial account number may be

identified by the last four digits when the financial account is the subject of the

case and cannot otherwise be identified. "Financial Account Numbers" include

financial institution account numbers, debit and credit card numbers, and

methods of authentication used to secure accounts such as personal identification

numbers, user names and passwords.

3. Driver License Numbers

4. State Identification (SID) Numbers

5. Minors' names and dates of birth except when a minor is charged as a defendant

in a criminal matter (see 42 Pa.C.S. § 6355). "Minor" is a person under the age of

eighteen.

6. Abuse victim's address and other contact information, including employer's

name, address and work schedule, in family court actions as defined by

Pa.R.C.P. No. 1931(a), except for victim's name. "Abuse Victim" is a person for

whom a protection order has been granted by a court pursuant to Pa.R.C.P. No.

1901 et seq. and 23 Pa.C.S. § 6101 et seq. or Pa.R.C.P. No. 1951 et seq. and 42

Pa.C.S § 62A01 et seq. If necessary, this information must be provided on

the separate Abuse Victim Addendum. Please note there are separate

instructions for the completion of the Addendum located on the form.

Please note this form does not need to be filed in types of cases that are sealed or exempted from

public access pursuant to applicable authority (e.g. juvenile, adoption, etc.).

•The best way to protect confidential information is not to provide it to the court.

Therefore, only provide confidential information to the court when it is required by

law, ordered by the court or is otherwise necessary to effect the disposition of a matter.

•Do not include confidential information in any other document filed with the court under this

docket.

•If you need to refer to a piece of confidential information in a document, use the alternate

references. If you need to attach additional pages, sequentially number each alternate reference

- i.e. SSN 3, SSN 4, etc.

•This form, and any additional pages, must be served on all unrepresented parties and

counsel of record.

A court or custodian is not required to review or redact any filed document for compliance with the Case

Records Public Access Policy of the Unified Judicial System of Pennsylvania. A party's or attorney's

failure to comply with this section shall not affect access to case records that are otherwise accessible.

If a filed document fails to comply with the requirements of the above referenced policy, a court of

record may, upon motion or its own initiative, with or without a hearing, order the filed document

sealed, redacted, amended or any combination thereof; a magisterial district court may, upon request or

its own initiative, redact, amend or both. A court of record may impose sanctions, including costs

necessary to prepare a compliant document for filing in accordance with applicable authority.

THIS FORM IS CONFIDENTIALRev. 7/2018

Abuse Victim Addendum

Instructions for Completing the Abuse Victim Addendum: The Abuse Victim Addendum shall accompany

a filing where confidential information is being provided by an abuse victim, as defined in this policy, in

family court actions (seePa.R.C.P. No. 1931(a)), as required by law, ordered by the court, or otherwise

necessary to effect the disposition of a matter. This addendum, and any additional pages, shall only be

provided to the court and shall remain confidential. The best way to protect confidential information is not to

provide it to the court. Therefore, only provide confidential information to the court when it is required by law,

ordered by the court or is otherwise necessary to effect the disposition of a matter.

Type of Family Court ActionType of Family Court Action

Divorce, Annulment, Dissolution of Marriage Child Custody

Support Paternity Protection from Abuse

This Information Pertains to: Confidential Information: References in Filing:

AV Address: Alternative Reference:

AV 1 Address

(full name of abuse victim) AV Employer's Name & Address: Alternative Reference:

AV 1 Employer's Name & Address

Docket/Case No. of Protection Order AV Work Schedule: Alternative Reference: