Florida Affidavit Form

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_____________________________
representative signature
_____________________________
representative printed name
State of FLORIDA
County of _______________
The foregoing instrument was acknowledged before me this _____ day of __________20___ by ________________________________
as _______________________________ for _______________________________. He/she q is personally known to me or q has
produced a ________________________________ as identification.
________________________________
(SEAL)
notary signature
________________________________
notary printed name
FL-2043-ACK
provides this form pursuant to Florida Statutes §117.05(13)(c)

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