Notice Of Name Change Form
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1STATE OF FLORIDA
NOTARY PUBLIC
AMENDED COMMISSION REQUEST
NOTICE OF NAME CHANGE
_________________________________________________
/
/
.
Type or print name in which commission is currently issued
Date of Birth
__________________________________________________
Sign your official signature as currently commissioned
_________________________________________________________
Type or print new commission name as it is to appear on your
Imprint current seal for
certificate
identification only
_________________________________________________________
/
/
.
Sign your new official signature, the same as your new
Date legal name changed
commission name
FILL IN YOUR CURRENT ADDRESSES AND PHONE NUMBERS:
_______________________________________________________
(
)
.
Physical home address, City and Zip
Area code and telephone number
_______________________________________________________
Indicate business name, unemployed or retired
_______________________________________________________
(
)
.
Business address, City and State
Area code and business telephone no.
MAIL TO:
± Business
± Home
OR
__________________________________________________________
Mailing Address
Please forward this form, along with applicable fees and your current commission to your
bonding agency. Your bonding agency will provide the rider to your notary public bond and
forward all forms to the Secretary of State’s office for processing.
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