Florida Affidavit Form

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State of FLORIDA
County of ______________
Sworn to (or affirmed) and subscribed before me this _____ day of _________________20_____ by
___________________________________________________________ of _____________________
name of officer, title
name
___________________________, a ___________________________ corporation, on behalf of the
of corporation
state or place of incorporation
corporation. He/she q is personally known to me or q has produced a _________________________
as identification. Description of document for which this notarization applies: ___________________
__________________________________________________________________________________.
_______________________________
FL Notary Public – Signature
_______________________________
(SEAL)
FL Notary Public – Printed Name
FL-2055-JUR
provides this form pursuant to Florida Statutes §695.25(2)

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