City of Portland

Public Record Exemption Request Form



If granted, an ORS 192.368 personal safety exemption allows the City of Portland to redact only:

  • Home address
  • Personal e-mail address
  • Personal telephone number

Note: These exemptions do not cover other types of information. For example, your name, work email, or business address are subject to disclosure.


A request for a Public Record Exemption MUST include the following:

  1. The name of or a clear description of the public record sufficient to identify it.
  2. A contact email address. Please use the contact information below if you need to use postal services instead.
  3. Evidence demonstrating that disclosing your home address, personal phone number, or email address would pose a danger to the safety of you or a family member residing with you. Evidence may include, but is not limited to:
  • Affidavits or declarations
  • Court records
  • Police reports or report numbers
  • Restraining orders
  • Stalking protective orders


More information can be found on the City of Portland's Safety Exemptions Website.


The City will make every effort allowable under law to keep all information and attachments submitted in this request confidential.


If you have any questions or concerns, please email PublicRecordSafetyExemption@portlandoregon.gov or call (503) 823-6040.

 

Confidentiality Request for the Form

 

Selecting "Yes" confirms your intention is to submit this form in confidence regardless of whether your exemption is granted or not.

Selecting "No" could result in the subsequent public disclosure of any nonexempt information provided in this form.

 
 

Contact Information

The information in this section, including your name, is generally not eligible for redaction if it appears in a public record outside of this form. The primary exception is if your "Contact Email" is the same as your exempted "Personal Email."

 
 
 
 
 

Only include family members who currently reside with you.

 
 

This is the email we will use to communicate with you regarding your request.

    

NOTE: If this is the same as a personal email address you are seeking to withhold from disclosure you must include it both here AND in the "Personal Email" field in the next section.

 
 

Personal Information to Exempt

I am requesting that the City of Portland withhold the following personal information and keep it confidential:

 

Personal electronic mail addresses sought to be kept confidential. Business, work, government, and other public accounts are not eligible for this exemption.

 

Residential address sought to be kept confidential.

 
 
 
 

Phone number sought to be kept confidential.

Phone
 
 

Identify the Records

Please indicate which records you would like the City of Portland to exempt by checking the appropriate boxes below. Providing as much detail as possible will greatly assist in successfully exempting your information.

 

Select all that apply

 

Provide enough information to locate and identify the records selected above. Include as much detail as possible for each selection. Helpful information might include:

  • Timeframes, dates, date ranges, approximate year.
  • Specific types of records, permits, forms submitted.
  • Names of classes, activities, events.
  • Employment positions applied for.
  • Bureaus or specific City employees with which you have worked or communicated.
  • Subjects or participants of messages or correspondence.
 
 
 

Explain How Your Safety is at Risk

Eligibility for Exemption ORS 192.368

To qualify for this exemption, you must provide evidence that disclosure of your home address, personal telephone number, or personal electronic mail address would pose a danger to your personal safety or that of a family member residing with you.


How to Provide Evidence

If you have supporting documentary evidence (e.g., police reports, court orders), please attach it below. If you do not have evidence to attach, provide as much detail as possible in your statement, including:

  • Specific incidents, such as threats or acts of violence.
  • Police report numbers, court orders, or references to criminal/civil proceedings.
  • Dates of 911 calls or non-emergency reports.
  • Contacts within the City of Portland who can verify your statements.


Examples of Statements

  • "I am a victim of domestic violence and am including related police report numbers."
  • "I have a protective/restraining order, temporary restraining order (TRO), or other court order, and can attach evidence."
  • "I have a stalker with a history of violence. These are the dates of 911 calls I have made about my situation."
  • "I have received direct threats to my life or safety, including the following examples (e.g., threatening messages, confrontations)."


Details to Include in Your Statement

Whether or not you have evidence to attach, include relevant details such as:

  • Documentation or reference numbers for legal, medical, or public safety records.
  • Dates and descriptions of incidents.
  • Information about individuals posing a threat (if safe to disclose).
  • Specific information about threats that have occurred (location, what was said, etc.)
 
 
 
Drop your files here
 
 

I agree that by typing my legal name below I am signing this form electronically. In submitting this request, I affirm that the information provided is accurate for the purpose of ORS 192.368.