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.
X
//
(Official Signature of Applicant) (Date)
*Note: If you affirm, you may omit the words
“So help me God.” Fla. Stat. §92.52
.
(Print or Type Name - name for which your commission will be issued.)
You may use an initial for your first or middle name but not for both.
For example, John K. Doe or J. King Doe are acceptable but not J.K. Doe, J. Doe or K. Doe.
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(5)(a)5) should be excluded from inspection under Public Records Law.
If Yes, please indicate what section of Florida Statutes provides this exemption in your particular situation:
IF YOU NEED ADDITIONAL GUIDANCE AS TO THE APPLICABILITY OF ANY PUBLIC RECORDS LAW EXEMPTION TO YOUR
SITUATION, PLEASE CONTACT THE OFFICE OF THE ATTORNEY GENERAL:
Office of the Attorney General
The Capitol, PL-01
Tallahassee, FL 32399
(850) 245-0158
###
2
PERSONAL INFORMATION
Full Name:
)elddiM( )tsriF( )tsaL(
Home Address:
)etatS( )ytiC( )teertS( (County) (Zip)
Place of Employment: Unemployed Retired
Business Address:
(Street) (City) (State) (County) (Zip)
Mail to: Home Business Other Address:
(Street/P.O. Box) (City) (State) (Zip)
Sex: Male Race: Asian
E-mail Address:
Female Black or African American
(or write “NONE”) Native American or Alaska Native
White
Home Phone:
Other: ________________________
(or write “NONE”)
Business Phone: Extension:
(or write “NONE”)
Florida Driver License (or other State of Florida Issued ID): Date of Birth: __________/__________/__________
(Month/Day/Year)
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 public commission 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 Florida notary public 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 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).)
If Yes:
__________/__________/__________
eussi saw noissimmoc ruoy hcihw rof emaN( )rebmun noissimmoC( )etad noitaripxe noissimmoC( d)
4. 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.)
5. 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.)
6. 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.)
7. Are you currently on probation? Yes No
AFFIDAVIT OF CHARACTER
STATE OF COUNTY
I, am unrelated to and have known
(Print or Type Name of Affiant) (Name of Applicant)
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
)piZ( )ytnuoC( )etatS( )ytiC( )teertS(
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: (_____) X
(or write “NONE”) (or write “NONE”) (Signature of Affiant)
1
NOTARY PUBLIC COMMISSION APPLICATION
Florida Department of State
Notary Commissions and Certications Section (850) 245-6975
Mail Application to:
American
Association
of Notaries, Inc.
P.O. Box 630601
Houston, TX 77263
(Signature of Florida Licensed Agent)
STATE OF FLORIDA
BOND OF NOTARY PUBLIC
FOR OFFICE USE ONLY
Approved by Department of State:
Secretary of State
Notary Commissions
STATE OF FLORIDA
KNOW ALL MEN BY THESE PRESENTS, That we,
as Principal, and
(Name of Applicant)
( )
)rebmuN enohpeleT( )ynapmoC yteruS fo emaN tnirpmI(
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.
X
(Signature of Applicant)
Signed and sealed this 02 fo yad
(Name of Surety Company)
(Address of Surety Company)
(Name of Bonding Agency or Company)
(Affix Surety Seal)
(Address of Bonding Agency or Company)
By
(Florida Licensed Agent Number)
(Printed name of Florida Licensed Agent)
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.
DS/DE 76 (3/04)
SURETY BOND
SURETY BOND
SURETY BOND
SURETY BOND
Instructions for Completing the Florida Notary Application
American Association of Notaries
®
• www.floridanotaries.com • 1-800-721-2663
1 Personal Information
• Enter your name as listed on your government-issued identification.
• Enter your home address. P.O. boxes are unacceptable.
• If unemployed, enter “n/a” for the place, business address, and phone number.
2 Eligibility Questions
If you answer “Yes” to questions 4,5,6, and 7, you must submit the following documents:
• Written statement regarding the nature and circumstances of the charge(s);
• Copy of the court judgment and sentencing order or a comparable court document; and
• If convicted, a copy of the Certificate of Restoration of Civil Rights (or pardon).
To obtain information about the restoration of civil rights, you may contact:
Office of Executive Clemency, 4070 Esplanade Way Tallahassee, FL 32399-2450
Phone: (850) 488-2952
3 Affidavit of Character
Have someone unrelated to you who has personally known you for at least one year or more
complete and sign the Affidavit of Character section.
4 Oath of Office
(Choosing your official notary name and signature)
1 - Print or type your name exactly as you want it on your notar
y commission to be issued.
The name you use on the oath of office section will be the official notary name that will be printed on
the notary commission that you will use when notarizing documents. Your notary seal and stamp must
also include the same name printed on your notary commission.
You can use your LEGAL first name (or a nickname of your legal first name, within reason) and your
LEGAL last name; the inclusion of your legal middle name or initial in your commissioned name is
optional.
For example, John Doe Public could be commissioned as:
• John Doe Public • Johnny Doe Public
• John D. Public • Johnny D. Public
• John Public • Johnny Public
2 - The signature you use to sign the oath of office will be the official notary signature that you will
use to notarize documents. Use a signature with which you are comfortable.
By signing the Oath of Office section, you are swearing that you have read Chapter 117, Florida
Statutes, and any amendments thereto, that you know the duties, responsibilities, limitations, and
powers of a Florida notary public, and that you will faithfully perform the duties of a notary public
in the State of Florida.
5 Bond
Type, print, and sign the bond section. Enter the same name and signature you used when completing
the Oath of Office section
7 Notary Education Course
(optional for renewing notaries)
All first-time notary applicants are required to complete a three-hour notary course available for free
a
t the Secretary of State’s website http://notaries.dos.state.fl.us/education/instructions.html
8 Mail Us Your Completed, Signed Application
(Photocopies are unacceptable)
Mail your completed and signed notary application, the oath of office, the bond, and the certificate of
course completion to:
AAN
P.O. BOX 630601, Houston, Texas 77263
We will review your application for accuracy and completeness, issue the bond, and file it with the
Governor's Office.
6 Bonding Agency Information
(
DO NOT COMPLETE THIS SECTION!
)
This section will be completed by the American Association of Notaries as your bonding company.
FLMI-0419
Please type or print clearly. All fields must be completed. Enter “N/A” if it does not apply.
