Florida Affidavit Form - Right Corner

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State of FLORIDA
ATTESTED
PHOTOCOPY
County of _____________
On this ____ day of ___________, 20_______, I attest that the
preceding document is a true, complete, and unaltered photocopy
made by me of___________________________________________
_______________________________________________________
which is dated ____________________ and contains only this page,
presented to me by the document's custodian, _________________
__________________________, and, to the best of my knowledge,
that the photocopied document is neither a vital record nor a public
record, certified copies of which are available from an official source
other than a notary public.
________________________
(SEAL)
notary public signature
________________________
notary public printed name
FL-2173-AFF
provides this form pursuant to Florida Statutes §117.05(12)(a)

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