Office of the General Counsel
Division of Real Estate
2601 Blair Stone Road
Tallahassee, Florida 32399-2202
Phone: 850.717.1193
Halsey Beshears, Secretary Ron DeSantis, Governor
LICENSE EFFICIENTLY. REGULATE FAIRLY.
WWW.MYFLORIDALICENSE.COM
NOTICE OF ESCROW DISPUTE/GOOD FAITH DOUBT
(Please Type or Print CLEARLY)
I. Broker Information
Name of broker ______________________________ Broker license no.___________________
Street address__________________________________Telephone_______________________
City__________________ State____ Zip____________
E-mail address _________________________ Brokerage firm__________________________
In compliance with Section 475.25(1)(d)1., Florida Statutes, Rule 61J2-10.032, Florida
Administrative Code, be advised that broker has (check one):
_____received conflicting demands
_____good faith doubt as to which party is entitled to the deposit in broker’s escrow account in
the amount of $_______________
Date _______________
II. Parties to the transaction
___Seller ___Landlord
Name ________________________________________________________________________
Street address or Box no. ________________________________________________________
City________________________________________ State__________ Zip________________
___Buyer ___Tenant
Name ________________________________________________________________________
Street address or Box no. ________________________________________________________
City________________________________________ State__________ Zip________________
III. Property
This notice concerns the property located at:
Street address _________________________________________________________________
City ________________________________________ State_________ Zip ________________
