Fillable Application Registration for Online Notary Public

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Application Registration for Online Notary Public

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Application Registration for Online Notary Public
Mail to: Florida Department of State, Division of Corporations, ATTN: Notaries PO Box 6327, Tallahassee, FL 32314
In person or courier service to: 2415 North Monroe St., Suite 810, Tallahassee FL 32303
PERSONAL INFORMATION
Full name:
(Last) (First) (Middle)
Name as Commissioned:
Home Address:
(Street) (City) (State) (County) (Zip)
Email Address:
Phone Number:
Florida Notary Commission Number:
Expiration:
Florida Notary ID:
Civil-Law Notary- Florida Bar Number:
Date appointed:
Commissioner of Deeds Expiration date:
I will use the following RON Service Provider in compliance with Florida Law: _____________________________
The applicant confirms:
1. The technology and processes they have chosen for use in performing online notarizations must satisfy the requirements set
forth in Ch. 117, Florida Statutes, and Ch. 1N-7, Florida Administrative Code.
2. They have submitted evidence of obtaining a bond in the amount of $25,000.
3. They have submitted evidence of Errors and Omission (E&O) insurance policy in the minimum amount of $25,000.
4. They have submitted a copy of their commission or appointment as a Notary Public, Civil-Law Notary, or Commissioner of
Deeds.
5. They have submitted payment of registration fee of $10 by check payable to the Florida Department of State.
6. They understand that suspension, revocation, expiration, or termination of the applicant’s Notary Public commission or
appointment as a Civil-Law Notary, or Commissioner of Deeds immediately deactivates an Online Notary Public’s
registration.
7. They have submitted evidence of completing a classroom or online course covering the duties, obligations and technology
requirements for serving as online notary public.
Under penalties of perjury, I declare that I have read the foregoing Registration for Online Notary and that the
facts stated in it are true.
Signature:
Print Name:
STATE OF FLORIDA
COUNTY OF
Sworn to, affirmed, and subscribed before me by means of ( ) physical presence or
(
) online notarization, this
20 , by who is personally known to me or who has
produced as identification.
Day of _________
[PLACE NOTARIAL SEAL]
Notary Signature:
Print Name:
Notary Public, State of Florida
My Commission Expires:
Form: DOC IN-7, R. 1N-7.001, F.A.C, effective 01/2020
STATE OF FLORIDA BOND OF
NOTARY PUBLIC OR
ONLINE NOTARY PUBLIC
FOR OFFICE USE ONLY
Approved by Department of State:
Secretary of State
Notary
Commissions
Form: DOC IN-7, R. 1N-7.001, F.A.C, effective 01/2020
STATE OF FLORIDA
KNOW ALL MEN BY THESE PRESENTS, That we;
as Principal, and
___________________________________________
(Name of Registrant)
(Imprint name of Surety Company) (Telephone Number)
as Surety Company, give bond payable to any individual who may be harmed as a result of a breach of duty
by said
applicant acting in his/her official capacity as a Notary Public OR Online Notary Public in the amount of Twenty-
Five
Thousand Dollars ($25,000) as assurance for the due discharge of the duties of his/her office of Notary Public
OR Online Notary Public and we do bind ourselves, and each of our heirs, executors and administrators, jointly and
severally. Liability under this bond is limited to $7500 for acts performed in the capacity of a Notary Public pursuant to
section 117.017(a), Florida Statutes
.
Applicant was, on the date of issuance of Notary Public commission, bonded in and for the State of Florida
as a Notary Public of Florida, to hold office for the term of four years in accordance with the Constitution and
Laws of this State.
Now, therefore, if said applicant shall faithfully discharge the duties of the office of Online Notary Public,
as
prescribed by law, then this obligation shall be void.
By:
(Signature of Registrant)
Signed and sealed the day of 20
(Name of Surety Company)
(Affix Surety Seal)
By
:
(Address of Surety Company)
(Name of Bonding Agency or Company)
(Address of Bonding Agency or Company)
(
-
Sig
-
na
-
ture
-
of Flor
-
ida
-
Li
-
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-
se
-
d A
-
ge
-
nt
(Florida Licensed Agent Number)
(Printed name of Florida Licensed Agent)
Section 817.234(1)(b), F.S. "Any person who knowingly and with intent to injure, defraud, or deceive any
insurer files a statement of
claim or an application containing any false, incomplete, or misleading information is guilty of a felony in the third degree."
This bond shall be for Twenty-Five Thousand Dollars ($25,000).
After execution by surety company, the bond must be submitted to the Department of State for approval
and filing before issuance of the registration of online notary public.
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Application Registration for Online Notary Public

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Completed 23 November 2021

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