Fill - Free fillable Form 4: 00 Y Package Only ear Notary PDF form

Why pay more when you can get everything you need to Become a Notary or

Renew your Commission fast and for one low price? Budget Notary

Services offers you a high quality, four-year Notary Package for only $81

plus tax, shipping and handling. This includes your required $7,500 bond,

state filing fees and a self-inking stamp guaranteed for the entire term of

your commission.

Apply for or renew your commission in 5 easy steps:

Step 1: Complete the enclosed Notary Public Commission Application and 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: Choose an optional Errors & Omissions Policy (see below).

Step 3: Complete the order form (on reverse).

Step 4: Return the above with your payment in the enclosed envelope.

Step 5: If you’re a first-time Notary, take the required online notary education course, which you’ll find

on our website: www.BudgetNotaryInsurance.com. Print, sign and return the completion

certificate to receive your commission.

Want to apply even faster?

Secure application and payment feature available at www.BudgetNotaryInsurance.com!

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!

Personal Protection Through "Errors & Omissions"

Your notary package includes a Bond that protects the public, not you. If you're sued - even wrongfully - legal

fees can be very expensive. We highly recommend Errors & Omissions Insurance for your protection. It's

affordable! A four-year insurance policy can cost less than one hour of legal representation.

$25,000 4-Year Policy $10,000 4-Year Policy $5,000 4-Year Policy

❏

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

In Tallahassee: 850.219.8137

BD-23 (09/20)

ERRORS & OMISSIONS INSURANCE POLICIES

Plus tax, shipping & handling

h h h h

ear 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

Standard Notary Package (Includes Self-Inking Notary Seal -

Don’t forget to select your stamp color)

$81.00 $1.05

ERRORS & OMISSIONS INSURANCE POLICIES - Highly Recommended

$ 5,000 4 Year Policy $18.00 n/a

$10,000 4 Year Policy $32.00 n/a

$25,000 4 Year Policy $50.00 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

Notary Bond & State Filing Fees (Seal not included) $67.00 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

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

✔ $7,500 Four Year Notary Bond

✔ Self-Inking Notary Seal

Choice of case color

✔ Live Customer Service

$6.00

Standard 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.

Want To Perform Remote Online Notarizations?

Visit www.BudgetNotaryInsurance.com for the required registration forms.

h h h h h h h h

h h h

Only

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 Black

Silver Fuchsia

Red (Default) White

Green & Blue Blue & Pink

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:

UMBER: EXPIRES:

BILLING ADDRESS:

SIGNATURE OF CARDHOLDER:

AYTIME PHONE NUMBER: EXT:

EMAIL ADDRESS:

( )

By providing your email address on the order form or application, you are opting in to receive emails such as

order statuses, renewal reminders, law updates and other notary related information.

P-514

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/P.O. Box) (City) (State) (Zip)

(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:

PO Box 5797

Tallahassee, FL 32314-5797

877.298.8274

BD-01

Mail Applications to:

A PPLICANT PLEASE SIGN BACK

P-514

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 “Yes” box 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.

STATE OF FLORIDA

BOND OF NOTARY PUBLIC

Secretary of State

Notary Commissions

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 Notary Public, in the amount of Seven Thousand Five Hundred Dollars ($7,500) as assurance for the due

discharge of the duties of his/her office of Notary Public and we do bind ourselves, and each of our heirs, executors and

administrators, jointly and severally.

Applicant was, on the date of issuance of commission, bonded as a Notary Public in and for the State of Florida, to hold

office for the term of four years in accordance with the Constitution and Laws of this State.

Now, therefore, if said applicant shall faithfully discharge the duties of the office of Notary Public, as prescribed by law,

then this obligation shall be void.

✔ __________________________________________

Signed and sealed this ______________ day of ___________________________________, 20__________.

_______________________________________________

By ____________________________________________

_______________________________________________

FOR OFFICE USE ONLY

Approved by Department of State:

BUDGET NOTARY SERVICES

(Name of Surety Company)

(Signature Of Applicant)

(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 5797 TALLAHASSEE, FL 32314-5797

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 Seven Thousand, Five Hundred Dollars ($7,500). After execution by surety company, the bond must be submitted to the

Department of State for approval and filing before issuance of the notary public commission.

Imprint Name of Surety Company

(Name of Applicant)

BD-02 DS/DE (03/04)

CONTINENTAL INSURANCE COMPANY

P. O. BOX 5077 SIOUX FALLS, SD 57117-5077

CONTINENTAL INSURANCE COMPANY (800) 331-6053

Please Sign Here

3 of 3

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

Form 4: 00 Y Package Only ear Notary

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank Form 4: 00 Y Package Only ear Notary Form

Related forms

Fillable Form 4: 00 Y Package Only ear Notary

Fill Online, Printable, Fillable, Blank Form 4: 00 Y Package Only ear Notary Form

Related forms

First 20 documents completely FREE!