Limited Surely Agent, Professional Boil Bond Agent Sworn Statement
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1DEPARTMENT OF FINANCIAL SERVICES
Division of Agent & Agency Services - Bureau of Licensing
200 E Gaines Street, Larson Building
Tallahassee FL 32399-0319
Limited Surety Agent, Professional Bail Bond Agent
Sworn Statement
Florida Statutes §648.34(1), states: “An application for licensure as a bail bond agent must be
submitted on forms prescribed by the department…” and §648.34(2)(d) requires that “The
applicant is vouched for and recommended upon sworn statements filed with the department by at
least three reputable citizens who are citizens of the same counties in which the applicant proposes
to engage in the bail bond business.”
The applicant being vouched for on this form:
First name
Middle
Last Name
Social Security #
I, the undersigned, hereby certify that the individual listed above, who has filed an application for
license-examination required as a limited surety (bail bond) agent is personally known to me and is
of good business reputation and of good moral character.
I also attest that I am a resident of a county where this applicant proposes to engage in the bail
bond business.
Signature
County of residence
Printed Name
Street Address
Phone Number
City, State Zip Code
A
(3)
TOTAL OF AT LEAST THREE
FORMS SHOULD BE SUBMITTED WITH YOUR APPLICATION FOR LICENSE
You are required by federal law to disclose your social security number on this form which is a part of your
Note:
application for licensure. Section 666(a)(13) of Title 42, United States Code, requires each state to obtain
the social security number of each applicant for a professional or occupational license on the application for
the license. The purpose of collecting social security numbers is for administration of the child support
enforcement provisions of Title IV-D of the Social Security Act. The Department of Financial Services also
uses social security numbers for identity verification purposes in conjunction with background checks of
applicants and for identity verification purposes in the Department’s electronic database for licensees and
applicants.
DFS-H2-1500
69B-221.155, F.A.C.
(06/11)
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