2. Florida Constitution, Article 1, Section 16(b)(5):
   Every victim is entitled to the following right, beginning at the time of his or her victimization: “The right to prevent disclosure of information or records that could be used to locate or harass the victim or the victim’s family, or which could disclose confidential or privileged information of the victim.”
4. Case Number*
6. I,*
   , as the victim and as my right, do hereby
8. (Please select one)*

   1. Elect
   2. Do Not Elect (I do not want my information to become public record.)
10. to have the Aventura Police Department disclose information or records that could be used to locate or harass me or my family, or which could disclose confidential or privileged information related to me.
12. I HAVE READ AND UNDERSTOOD THE ABOVE PARAGRAPH. I HAVE BEEN INFORMED OF MY RIGHT UNDER THE CONSTITUTIONAL PROVISION REFERENCED ABOVE.
14. Victim's Signature*
    (If the victim is under age 18, a parent or guardian’s signature should be obtained.)
15. Date*
    Date
19. On Behalf of the Victim
21. Parent/Guardian Name
23. Parent/Guardian Signature
24. Date
    Date
26. Name of Next of Kin of Homicide Victim
    (if applicable)
28. Next of Kin Signature
29. Date
    Date
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field