Mental Health (Probate/Baker Act) Form

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ABSOLUTE DIGITAL INC.

33 SW 2nd Ave, Suite# 701
Miami, Fla. 33130
Tel: (305) 379-4741, Fax: (305) 379-3913

OFFICIAL REQUEST FORM MENTAL HEALTH
( PROBATE/ BAKER ACT)

Audio orders will not be processed until satisfactory payment arrangements are made for required fees. Failure to provide correct information will delay the process.

Disclaimer: Absolute Digital Inc. does not guarantee the quality of transcripts produced with unmonitored recordings due to among others the low audio quality or lack of speaker identification.

PLEASE PRINT CLEARLY:

Date of Proceeding*

MonthDay Year

Time*

:Hour Minutes AM/PM Option

Petitioner’s Name:*

Respondent’s Name:*

Case Number(s):*

Presiding Judge: *

Courtroom Number:*

Requested by:*

Pro se (without an attorney)Private AttorneyOther

Type of request:*

Audio 10 day delivery ($50 search fee)Audio 3 day delivery ($100 search fee)Audio overnight ($150 Search fee)Transcript (page rate)Transcript Excerpt (page rate and $50/hr listening fee)

Original + Copies (All orders after 3:00 p.m. are consider as next business day orders)

ORDERING PARTY INFORMATION

Name:*

Phone Number:*

Mailing Address:*

Ordering Party Signature*

Clear

Date Requested*

Date Needed*

If you are a person with a disability who needs any accommodation in order to place a request,
pay for services or pick up a document, contact Absolute Digital Inc. at
(305) 379-4741 (press 0) for voice and (305) 379-3913 for fax.

Prohibition Against Dissemination

RELEASE OF AUDIO/VIDEO RECORDING OF COURT PROCEEDING TO ATTORNEY OF RECORD OR PARTY

CASE STYLE: *

DATE AND TIME OF PROCEEDING:*

CASE NO.: *

The audio/video recording of the above-referenced court proceeding may contain information that is confidential or exempt from public disclosure by court order or under Florida or Federal law. dissemination of this recording or information to any other person is strictly prohibited, except as permitted by law, rule or court order. Violation of this prohibition may subject you to legal action, including but not limited to an action for contempt of court.

Prior to release of the recording to a member of the general public, the AdministrativeOffice of the Courts (AOC) is required to review the recording for confidential or exempt information, and redact such information from the recording. You may not undertake such redaction and dissemination. Only the AOC may redact and/or disseminate recordings that contain confidential information.

I,

Name*

am an attorney of record or a party in the above-referenced court case. Pursuant to Florida Supreme Court AOSCI 1-22, I acknowledge that I have read this Prohibition Against Dissemination and understand that further dissemination of the audio/video recording provided to me is strictly prohibited and may subject me to legal action for contempt of court. I further acknowledge that I was offered and am hereby refusing to accept and pay the cost for redaction of a version of the recording with all confidential information redacted, which would not be prohibited from further dissemination. By my signature below, I acknowledge, understand, and agree to comply with this Prohibition Against Dissemination.

Signature Requestor*

Clear

Date*

Requester's Name:*

Requester's Address: *

Requester's Email:*

Requester's Telephone:*

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