Notary Public Commission Application Form Page 2
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1
2FOR OFFICE USE ONLY
STATE OF FLORIDA
Approved by Department of State:
BOND OF NOTARY PUBLIC
Secretary of State
Notary Commissions
STATE OF FLORIDA
KNOW ALL MEN BY THESE PRESENTS, That we,
as Principal, and
(Name of Applicant)
(
)
(Imprint Name of Surety Company)
(Telephone Number)
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
day of
20
(Name of Surety Company)
(Address of Surety Company)
(Name of Bonding Agency or Company)
(Affix Surety Seal)
(Address of Bonding Agency or Company)
X
By
(Signature of Florida Licensed Agent)
(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)
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