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FLORIDA NOTARARIAL CERTIFICATE
(OATH OR AFFIRMATION SIGNED BY MARK)
1. _______________________________ _______________________________
Printed Name and Address of Witness Signature of Witness
2. _______________________________ _______________________________
Printed Name and Address of Witness Signature of Witness
_______________________________
His (or Her) Mark
STATE OF FLORIDA
COUNTY OF _________________
Sworn to (or affirmed) and subscribed before me this ___ day of _________________, 20___,
by _________________ (Name of Person Making Statement), who signed with a mark in the
presence of these witnesses: _______________________________ (Names of Witnesses).
(Seal)
_______________________________
Signature of Notary Public
_______________________________
Print, Type or Stamp Name of Notary
Personally Known: ____
OR Produced Identification: ____
Type of Identification Produced: _________________