State Of Florida Notary Form

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Witness 1: X_____________________________
_____________________________________
(First Name)
(Last Name)
_________________________________
PRINT:
_________________
______________________________________
(His/Her Mark)
(Street Address)
______________________________________
(City, State, Zip)
Witness 2: X____________________________
_________________________________
PRINT:
___________________________________________________
(Street Address)
______________________________________
(City, State, Zip)
State of FLORIDA
County of _________________
Sworn to (or affirmed) and subscribed before me this _______ day of _______________ 20_____, by
_______________________________, who signed by way of mark in the presence of the above named
witnesses and who q is personally known to me or q produced a _______________________________ as
identification.
Description of instrument attached _________________________________________________________
____________________________________________________________________________________.
______________________________
(SEAL)
notary public signature
______________________________
notary public printed name
FL-2113-JUR
provides this jurat pursuant to Florida Statutes §117.05(14)(c)(1)

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