Notary Application Step 1 of 8 - Personal Information 12% First Name*Middle NameLast Name*Your full name as you would like it to appear on your Notary Seal*Home Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Address County* Place of EmploymentIf not employed: Unemployed Retired Business Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Address County* Mail to:* Home Business Other Address Other Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Sex* Male Female Race:* Asian Black or African American Native American or Alaska Native White Other Other Race:*Email Address* Home Phone*Business Phone (or type "None")* Florida Driver's License (or other State of Florida Issued ID)*Please enter your FL driver's license number.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 public commission application and are exempt from disclosure pursuant to Fla. Stat. §119.017(5)(a)5. The State of Florida requires an Affidavit of Character from someone who is not related to you and has known you for at least one year.You do not have to choose your affiant right now. If you already know who it will be, enter their information below and it will print on your application. If not, leave this page blank and click Next — the affidavit section must be completed and signed by your affiant before you mail in your application, and you can fill it in by hand on the printed form.Affidavit of CharacterAffiant's Full Name (printed)The person vouching for you. Must be unrelated to you and have known you for at least one year. You can leave this page blank for now and fill it in by hand on the printed application.Affiant's Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Affiant's CountyAffiant's Home Phone (or type "NONE")Affiant's Work Phone (or type "NONE") 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.)Are you a United States citizen?* Yes No (If No, you must submit a recorded Declaration of Domicile. You must obtain this document from your local county courthouse.)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.)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, Commission expiration date* Previous commission number*Name which your commission was issued*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 of your commissions 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.)Have you been disciplined by a regulatory agency, including 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.)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.)Are you currently on probation?* Yes No 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 applications submission, please check the following box.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. You may find possible exemptions on this Public Records Exemption Guide: https://dos.myflorida.com/media/695951/dos119.pdf 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. You may find possible exemptions on this Public Records Exemption Guide: https://dos.myflorida.com/media/695951/dos119.pdfIf Yes, please indicate which section of Florida Statutes provides this exemption from the Public Records Exemption Guide.*https://dos.myflorida.com/media/695951/dos119.pdf *The attached DOS Public Records Exemption Request form is to act as a guide to assist applicants and does not have to be submitted if the "Yes" box is not checked. Errors & Omissions (E&O) Insurance*E&O insurance protects you financially if you make an unintentional mistake during a notarization. It is optional and is added to your order at checkout. $5,000 E&O @ $20.00 $10,000 E&O @ $35.00 $15,000 E&O @ $60.00 $25,000 E&O @ $75.00 $30,000 E&O @ $80.00 No. I, personally, decline this coverage. Florida Notary Commission Application Package Price: Includes State of Florida filing fees, official commission certificate, $7,500 notary bond, notary stamp, and online application management.$5,000 E&O Insurance Coverage Price: $10,000 E&O Insurance Coverage Price: $15,000 E&O Insurance Coverage Price: $25,000 E&O Insurance Coverage Price: $30,000 E&O Insurance Coverage Price: Processing and Handling Price: Includes State of Florida filing fees, official commission certificate, $7,500 notary bond, notary stamp, and online application management.Shipping Includes State of Florida filing fees, official commission certificate, $7,500 notary bond, notary stamp, and online application management. Total $0.00 Payment Details
