Why pay more when you can get everything you need to renew your
commission with remote online notary bond fast and for one low
price? Budget Notary Services offers you a high quality, four-year
Notary Package for only $168 plus tax, shipping and handling. This
includes your required $25,000 online bond, $25,000 Errors &
Omissions policy, state filing fees and a self-inking stamp guaranteed
for the entire term of your commission.
Apply for or renew your commission in 4 easy steps:
Step 1: Complete the enclosed Notary Public Commission Application and Remote Online
Notary Bond, including the state-required Driver’s License and Social Security numbers.
These may be used by the state for a background check.
Step 2: Complete the order form (on reverse).
Step 3: Return the above with your payment to Budget Notary Services.
Step 4: If you’re a first-time Notary, take the required notary education course, which you’ll find
on our website: www.BudgetNotaryInsurance.com. Print, sign and return the
completion certificate to receive your commission. This course is for first-time notary
applicants and does not meet the remote online education requirement.
Budget Notary is a state approved, reliable notary bonding agency focused on personal service.
Applications are hand delivered to the Secretary of State's office. For high quality and low cost use
Budget Notary Services!
P.O. Box 5797 h Tallahassee, FL h 32314-5797 h
“Serving ALL Your Notary Needs”
Apply or Renew Online
www.BudgetNotaryInsurance.com
Toll Free Number: 877.298.8274
h
In Tallahassee: 850.219.8137
BD-25 (02/20)
Plus tax, shipping & handling
$
168
00
Traditional & Remote
Online
Notary Package Only
Because we are located in Tallahassee,
we maintain a close working
relationship with the Secretary of State’s
office to provide YOU faster service!
Click: www.BudgetNotaryInsurance.com h Call: 877.298.8274 h Follow Us:
Subtotal
Shipping & Handling
TOTAL
ORDERING OPTIONS
Description Price
Add Tax
Cost
Traditional & Remote Online Notary Package
(Includes Self-Inking Notary Seal - Don’t forget to select
your stamp color)
$168.00 $1.05
Customize Your Package
$25,000 Remote Online Notary Bond, $25,000 Errors &
Omissions Policy and State Filing Fees (Select notary stamp
and additional supplies below)
$154.00 n/a
ADDITIONAL SUPPLIES
Notary Public Record Book $8.00 $0.60
Self-Inking Notary Seal (Extra for home or office - select
stamp color)
$14.00 $1.05
Travel Stamp (Select stamp color) $25.50 $1.91
Florida Notary Handbook $12.75 $0.96
Embossing Seal (Additional colors available online) $28.50 $2.14
Self-Inking Round Notary Stamp (Select stamp color) $25.00 $1.88
Personalized Display Sign $15.00 $1.13
Marriage Kit $28.00 $2.10
Notary Education Course (Required for first time applicants) $22.00 n/a
For Additional Application Forms and
Notary Supplies Visit Us at
www.BudgetNotaryInsurance.com
No sales tax on State Fees, Bond, E&O Policies or education course.
Notary Bonds and Notary Errors & Omissions policies are underwritten by
Western Surety Company and Continental Insurance Company.
If we cannot process your order within 12 months due to lack of
information, we are no longer obligated to fulfill your order and
payment becomes non-refundable.
State Filing Fees
$
39
00
$25,000 Remote Online Notary Bond
$
65
00
$25,000 Errors & Omissions Policy
$
50
00
Self-Inking Notary Seal
$
14
00
Choice of case color
Live Customer Service
$6.00
Traditional & Remote Online
Notary Package Includes . . .
NOTARY EDUCATION COURSE
Required for first time applicants (Recommended for renewing notaries)
Budget Notary’s state-approved online Notary Education Course
satisfies the requirement for first-time notaries. It’s also valuable for
renewing notaries, but not required.
We offer two options for payment. Take the course immediately and
submit the $22 payment online using our website at:
www.BudgetNotaryInsurance.com. Or, include the fee with this
order form and we’ll send you a confirmation link.
No test is required, but first-time notaries must print, sign and
return the course completion certificate to be commissioned. This
course does not meet the remote online education requirement.
$
168
00
h h h h h h h h
Only h h h h
h PRODUCTS AND ORDER INFORMATION h
SELF-INKING
NOTARY SEAL
TRAVEL STAMP
FLORIDA NOTARY
HANDBOOK
NOTARY PUBLIC
RECORD BOOK
EMBOSSING SEAL
This handheld model embosser
is small enough to easily travel
with you, while still leaving a
clear, raised lasting impression.
Additional colors available online.
This new compact stamp is
perfect if you are always on
the go.
Everything you need to know
about being a Florida notary.
This easy to understand
manual helps you notarize
lawfully and confidently.
With room for 256 entries,
and the basic guidelines for
performing a notarization, this
is a must have product.
Blue Charcoal
Silver Green
Red (Default) Fuchsia
Orange Yellow
SELF-INKING ROUND
NOTARY STAMP
This easy to use stamp meets
all notary law provisions, and
doesn’t require a separate ink
pad. Includes a cap for easy
mess free carrying.
This easy to use stamp doesn’t
require a separate stamp pad.
Purple Fuchsia
Black Green
White Grey
Blue Red (Default)
Plus tax, shipping & handling
Black
Blue
Red (Default)
PAYMENT OPTIONS
CHECK OR MONEY ORDER ENCLOSED (made payable to BUDGET NOTARY SERVICES)
❏❏❏❏
CARDHOLDER NAME:
N
UMBER: EXPIRES:
BILLING ADDRESS:
SIGNATURE OF CARDHOLDER:
E
MAIL ADDRESS:
DAYTIME PHONE NUMBER: EXT:
( )
For Notary Law Updates, Product Information & Order Status Updates
P-506
NOTARY PUBLIC COMMISSION APPLICATION
Florida Department of State
Notary Commissions and Certifications Section (850) 245-6975
PERSONAL INFORMATION
Full Legal Name:
Home Address:
Place of Employment: Unemployed Retired
Business Address:
Mail to: Home Business Other Address:
E-Mail Address:
Home Phone: ( )
Business Phone: ( ) Extension
Florida Driver's License (
or other State of Florida Issued ID): Date of Birth:
Social Security Number:
The disclosure of a Florida notary public applicant’s social security number is expressly required by Fla. Stat. §117.01(2) and is imperative for processing notary public
commission applications. Please be advised that social security numbers are only used for processing the notary application and are exempt from disclosure pursuant
to Fla. Stat. §119.071(5)(a)5.
1. Are you a legal resident of Florida? Yes No (If No, you are not eligible to apply for a notary commission. Legal residency must be maintained throughout the
appointment.)
2. Are you a United States citizen? Yes No (If No, you must submit a recorded Declaration of Domicile. Obtain this document from your county courthouse.)
3. Are you a wartime veteran with a disability rating of 50 percent or more? Yes No (If Yes, you must submit a written request for the fee reduction and
provide proof of exemption.)
4. Are you now or have you ever been commissioned a Notary Public in the State of Florida? Yes No (If No, you must complete a 3 hour notary
education course and submit a signed certificate of completion. Fla. Stat. §668.50 (11)(b).) Go to www.BudgetNotaryInsurance.com to complete the notary course.
If Yes:
5. Have you held any professional licenses or commissions (other than Notary Public) in Florida during the past 10 years? Yes No
(If Yes, please list.)
Have any been revoked? Yes No (If Yes, you must submit a written statement about the nature of the action and a copy of the Final Order from the regulating agency.)
6. Have you been disciplined by a regulatory agency, including The Florida Bar, and including disciplinary action that is confidential?
Yes No
(If Yes, you must submit a written statement about the nature of the action and any supporting documentation, such as a copy of the Final Order from the regulating
agency.)
7. Have you been convicted of a felony or have you had an adjudication of guilt withheld for a felony offense?
Yes No
(If Yes, you must submit a written statement of the nature of the offense(s), a copy of the court judgment and sentencing order. If convicted, you must submit a
certificate of Restoration of Civil Rights.)
8. Are you currently on probation? Yes No
AFFIDAVIT OF CHARACTER
STATE OF County
I, am unrelated to and have known
for one year or more; and to the best of my knowledge and observation know him or her to be of good character.
My address is .
UNDER PENALTY OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING AFFIDAVIT AND THAT THE FACTS STATED IN IT ARE TRUE.
Home Phone: ( ) Work Phone:( )
(Last) (First) (Middle)
(Street) (City) (State) (County) (Zip)
(Street) (City) (State) (County) (Zip)
(Street/P.O. Box) (City) (State) (Zip)
(or write “NONE”)
(or write “NONE”)
(or write “NONE”)
(Month/Day/Year)
(Street) (City) (State) (County) (Zip)
(or write “NONE”) (or write “NONE”) (Signature of Affiant)
(Name of Applicant)
(Print or Type Name of Affiant)
(Commission expiration date) (Commission number) (Name in which your commission was issued)
Sex: Male Race: Asian
Female Black or African American
Native American or Alaska Native
White
Other:
1
PO Box 5797
Tallahassee, FL 32314-5797
877.298.8274
BD-01
Mail Applications to:
APPLICANT PLEASE SIGN BACK
P-506
OATH OF OFFICE
STATE OF FLORIDA County
I do solemnly swear (or affirm) that I will support, protect, and defend the Constitution and Government of the United States and of the State of
Florida; that I am duly qualified to hold office under the Constitution of the state; that I have read Chapter 117, Florida Statutes, and any
amendments thereto, and know the duties, responsibilities, limitations, and powers of a notary public; and that I will well and faithfully perform the
duties of Notary Public, State of Florida, on which I am now about to enter. So help me God.*
UNDER PENALTY OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING APPLICATION AND OATH, AND THAT THE FACTS
STATED THEREIN ARE TRUE. I accept the Office of Notary Public, State of Florida.
MEMORANDUM
AS A GENERAL MATTER, APPLICATIONS FOR ALL POSITIONS WITHIN STATE GOVERNMENT ARE PUBLIC RECORDS, WHICH MAY BE
VIEWED BY ANYONE UPON REQUEST. HOWEVER, THERE ARE SOME EXEMPTIONS FROM THE PUBLIC RECORDS LAW FOR
IDENTIFYING INFORMATION RELATING TO SOCIAL SECURITY NUMBERS, PAST AND PRESENT LAW ENFORCEMENT OFFICERS AND
THEIR FAMILIES, VICTIMS OF CERTAIN CRIMES, ETC. IF YOU BELIEVE AN EXEMPTION FROM THE PUBLIC RECORDS LAW APPLIES TO
YOUR FLORIDA NOTARY PUBLIC COMMISSION APPLICATION SUBMISSION, PLEASE CHECK THE FOLLOWING BOX:
Yes, I assert that identifying information provided in this application (other than my social security number, which I am aware is automatically
exempt from public disclosure, pursuant to Fla. Stat. §119.071) should be excluded from inspection under Public Records Law.
If Yes, please indicate what section of Florida Statues provides this exemption. If you are unsure of the Florida Statute, use the link
below to download and complete the Public Records Exemption Request forms:
https://dos.myflorida.com/media/695951/dos119.pdf
The DOS Public Records Exemption Request forms are to act as a guide to assist applicants and does not have to be submitted if
the “Yesbox is not checked.
(Official Signature of Applicant)
(Print or Type Name - name for which your commission will be issued.) Must use legal first name, no initial.
Acceptable Options: Jonathan David Doe, Jon D. Doe, Jonathan Doe, Jonathan D. Doe
(Date) MM-DD-YYYY
*Note: If you affirm, you may omit the words
“So help me God.” Fla. Stat. §92.52.
2
STATE OF FLORIDA BOND OF
NOTARY PUBLIC OR
ONLINE NOTARY PUBLIC
Secretary of State
Online Notary Commissions
Form: DOC IN-7, R. 1N-7.001, F.A.C, effective 01/2020
STATE OF FLORIDA
KNOW ALL MEN BY THESE PRESENTS, That we,
__________________________________________________________________________________ as Principal, and
__________________________________________________________ as Surety Company, give bond payable to any
individual who may be harmed as a result of a breach of duty by said applicant acting in his/her official capacity as a
Notary Public OR Online Notary Public in the amount of Twenty-Five Thousand Dollars ($25,000) as assurance for the
due discharge of the duties of his/her office of Notary Public OR Online Notary Public and we do bind ourselves, and each
of our heirs, executors and administrators, jointly and severally. Liability under this bond is limited to $7500 for acts per-
formed in the capacity of a Notary Public pursuant to section 117.01(7)(a), Florida Statutes.
Applicant was, on the date of issuance of Notary Public commission, bonded in and for the State of Florida as a Notary
Public of Florida, to hold office for the term of four years inaccordance with the Constitution and Laws of this State.
Now, therefore, if said applicant shall faithfully discharge the duties of the office of a Notary Public or Online Notary Public,
as prescribed by law, then this obligation shall be void.
__________________________________________
Signed and sealed this ______________ day of ___________________________________, ____________.
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
By ____________________________________________
_______________________________________________
_______________________________________________
FOR OFFICE USE ONLY
Approved by Department of State:
Western Surety Company (800) 331-6053
Western Surety Company
BUDGET NOTARY SERVICES
A068326
Jack Diestelhorst
(Name of Surety Company)
(Signature of Registrant)
(Address of Surety Company)
(Name of Bonding Agency or Company)
(Address of Bonding Agency or Company)
(Signature of Florida Licensed Agent)
(Florida Licensed Agent Number)
(Printed Name of Florida Licensed Agent)
P. O. BOX 5077, Sioux Falls, SD 57117-5077
P. O. Box 5797, Tallahassee, FL 32314-5797
Imprint Name of Surety Company
(Name of Registrant)
Section 817.234(1)(b), F.S. "Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of
claim or an application containing any false, incomplete, or misleading information is guilty of a felony in the third degree."
This bond shall be for Twenty-Five Thousand Dollars ($25,000).
After execution by surety company, the bond must be submitted to the Department of State for approval
and filing before issuance of the registration of online notary public.
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