Complete Report

Clients with Commissions

Last NameMiddle NameFirst NameYour full name as you would like it to appear on your Notary SealUser Email AddressHome AddressHome Address CountyPlace of EmploymentBusiness AddressBusiness Address CountyMail to:Mail to Address:SexRace: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 BirthSocial Security NumberAre 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 dateCommission numberName for which your commission was issuedHave 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(other than Notary Public) in Florida during the past 10 years?If Yes, please list:Have any of your commissions been revoked?Have you been disciplined by a regulatory agency, including Florida bar, and including disciplinary action that is confidential?Have you been convicted of a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 NumberPrinted Bond NumberE&O Policy Ends dateE&O Limit writtenE&O Limit currencyE&O PremiumE&O NetUpload ApplicationUpload BondUpload E&OUpload RON ApplicationUpload Miscellaneous documentsMilestone #1Milestone #2Milestone #3Milestone #4 - RON Application SentCommission NumberNotary IDEffective DateExpiration DateRONEntry IDEntry DateUser
Last NameMiddle NameFirst NameYour full name as you would like it to appear on your Notary SealUser Email AddressHome AddressHome Address CountyPlace of EmploymentBusiness AddressBusiness Address CountyMail to:Mail to Address:SexRace: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 BirthSocial Security NumberAre 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 dateCommission numberName for which your commission was issuedHave 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 NumberPrinted Bond NumberE&O Policy Ends dateE&O Limit writtenE&O Limit currencyE&O PremiumE&O NetUpload ApplicationUpload BondUpload E&OUpload RON ApplicationUpload Miscellaneous documentsMilestone #1Milestone #2Milestone #3Milestone #4 - RON Application SentCommission NumberNotary IDEffective DateExpiration DateRONEntry IDEntry DateUser
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