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| Last Name | Middle Name | First Name | Your full name as you would like it to appear on your Notary Seal | User Email Address | Home Address | Home Address County | Place of Employment | | Business Address | Business Address County | Mail to: | Mail to Address: | Sex | Race: | Other Race: | Email Address (or type "NONE") | Home Phone (or type "NONE") | Business Phone (or type "NONE") | Florida Driver License (or other State of Florida Issued ID) | Date of Birth | Social Security Number | Are you a legal resident of Florida? | Are you a United States citizen? | Are you a wartime veteran with a disability rating of 50 percent or more? | Are you now or have you ever been commissioned a Notary Public in the State of Florida? | If Yes, Commission expiration date | Commission number | Name for which your commission was issued | Have you held any professional licenses or commissions (other than Notary Public) in Florida during the past 10 years? | If Yes, please list: | Have any of your commissions been revoked? | Have you been disciplined by a regulatory agency, including Florida bar, and including disciplinary action that is confidential? | Have you been convicted of a felony, or have you had an adjudication of guilt withheld for a felony offense? | Are you currently on probation? | | Yes, | If Yes, please indicate which section of Florida Statutes provides this exemption from the Public Records Exemption Guide. | Bond Number | Printed Bond Number | E&O Policy Ends date | E&O Limit written | E&O Limit currency | E&O Premium | E&O Net | Upload Application | Upload Bond | Upload E&O | Upload RON Application | Upload Miscellaneous documents | Milestone #1 | Milestone #2 | Milestone #3 | Milestone #4 - RON Application Sent | Commission Number | Notary ID | Effective Date | Expiration Date | RON | Entry ID | Entry Date | User |
| Last Name | Middle Name | First Name | Your full name as you would like it to appear on your Notary Seal | User Email Address | Home Address | Home Address County | Place of Employment | | Business Address | Business Address County | Mail to: | Mail to Address: | Sex | Race: | Other Race: | Email Address (or type "NONE") | Home Phone (or type "NONE") | Business Phone (or type "NONE") | Florida Driver License (or other State of Florida Issued ID) | Date of Birth | Social Security Number | Are you a legal resident of Florida? | Are you a United States citizen? | Are you a wartime veteran with a disability rating of 50 percent or more? | Are you now or have you ever been commissioned a Notary Public in the State of Florida? | If Yes, Commission expiration date | Commission number | Name for which your commission was issued | Have you held any professional licenses or commissions (other than Notary Public) in Florida during the past 10 years? | If Yes, please list: | Have any of your commissions been revoked? | Have you been disciplined by a regulatory agency, including Florida bar, and including disciplinary action that is confidential? | Have you been convicted of a felony, or have you had an adjudication of guilt withheld for a felony offense? | Are you currently on probation? | | Yes, | If Yes, please indicate which section of Florida Statutes provides this exemption from the Public Records Exemption Guide. | Bond Number | Printed Bond Number | E&O Policy Ends date | E&O Limit written | E&O Limit currency | E&O Premium | E&O Net | Upload Application | Upload Bond | Upload E&O | Upload RON Application | Upload Miscellaneous documents | Milestone #1 | Milestone #2 | Milestone #3 | Milestone #4 - RON Application Sent | Commission Number | Notary ID | Effective Date | Expiration Date | RON | Entry ID | Entry Date | User |
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