STATE OF ___________________
COUNTY OF _________________
Before me, the undersigned authority, personally appeared _____________________________________ (“Affiant”), who swore or (Attorney in Fact) affirmed that:
_________________________________________. (Person Making Statement)
STATE OF FLORIDA
Sworn to (or affirmed) and subscribed before me by means of ☐ physical presence or ☐ online notarization, this ___ day of ________, 20____, by ___________________ (name of person making statement).
Personally Known ☐ OR Produced Identification ☐
Type of Identification Produced: ____________________
(Signature of Notary Public)
(Print, Type, or Stamp Commissioned Name of Notary Public)
Affix Notary SEAL
Online Notary: ☐ (Check Box if acknowledgment done by Online Notarization)
For issuing guidelines on this form, see Guidelines.