HomeMy WebLinkAboutInv# SP01242022 - NOTARY PUBLIC UNDERWRITERS - 01/24/2022M audeline J. C igueneJanuary 24, 2022
January 24,
2022 $111.80
N otary P ublic U nderwriters, Inc.
P.O. Box 5378
Tallahassee
FL 32314-5378
001-17-01-513-54-20 $111.80
✔S herry P ecoraro
C RA C ity H all
Onusn Fonu 1.800.821.0821 . www.NotarypublicUnderwriters.co* . Il tj N
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PO. Box 5378 . Tallahassee, FL 32-314-5378
800.82 1.0821 . intb.fl@npuonline.com
Want To Perform Remote Online Notarizations?
Visit www.NotaryPublicUnderwriters.com for the required registration forms.
Ononn Orve or Tnnsn
Couprnrr Noreny Pecrecns !
Premium Notary Package
' 4Year $7,500 Notary Bond - $40.00 $103m. State Filing Fees - 939.00
' Rectangular Self-Inking Stamp - $24.00 (ptra r,rt-)
(Your choi.e of stairp cdse aolor!)
Classic Notary Package
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4 Year $7,500 Notary Bond - $40.00
State Filing Fees - $39.00
Round SelfJnking Stamp - 527.00 (prrJ rax)
(\bur .hoire oI nanp .ns. @l!y!)
$10600
Choose yo
Rectangular
Deluxe Notary Package
' 4 Year $7,500 Notary Bond - $40.00 $173N- Stare Filing Fees - $39.00
. Reaangular Self-Inking Stamp - $24.00 (ptrr ra.rr.)
(Your thoLe of stamg case color!)
' Notary Public Record Book - $10.00 lnar rar'1
' $25,000 Errors & Omissions Policy - $60.00
* Snle; nt on tangiblc NLtdutts al 1,.
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Self-Inking Stamp;;;;; EI Purplc O Bltte O rwtuin \Grun A Grq D LiLlcTIEE;EE
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See Details About our
Online Notarv Education
E Aililitional'Products on
Reverse Siile!
sts rs
'* Fotuld la]/, requircs frst ,imc l:lorida appl;cants takc a dlucation cou\e.
lf we coanot pro*ss 1,out orde, n ithh ) 2 fionths ilue to lack ol infoftnatioll, $/e are
no longt obhgottd to fulfll your arilu aad payment becomes non-rcftnilabb.
E Check/voney Older E G,'t3'vrsA tr Card No.
Signature of Cardholder:
AMoI,,NT
ENcLoSED
T{TINY
Cardholder's Name BillingZp Code:_ Danime phone:
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Email Address:
you frovid. on drc ord$ form or apllidtion
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wil br us.d ro.orr&t y6u rbour prlBsing yourror credir Card ,\urho.i2. ri.. Only
Prcmium Notary Package t./r.,rj. n,rrrl ./,jr (a,L,$r0-1.00 lcr.{.80
Classic Notary Package / ./rDoj. Jl.rrp jrln, .01.r,s 106.00 $2.03
Deluxc Notary Package tl,oo-ir srrr:rp iarr a:/or)$ 173.00 $2.ss
Notary Bond & Statc Filing Fees
$ 10,000 Errors & Omissions Policy
$79.00
$40.00
NiA
N/A
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$ 25,000 Errors & Omisions Policy s50.00 N/A
$ 50,000 Erors & Omissions Policy s120.00 NiA
$t00,000 Errors & Onissions Policy
Online Notary Education Course t.pri,rr,r/d r r$evinS na,,lt-itt\,,
s240.00
$25.00
I N/A
N/A
Notarv Public Record Book s10.00
Heary Duty Round Selt'-lnl{ng Stamp $38.00 s2.85
Round Sdf-lnking Stanp i.fu,o-r. irdnp rlrjr.dl.r')$27.00 $2.0.1
Rectangular Self-Inking Stamp a.ruor. rrrrtrp ..rrc..,i{,, )$24.00 $1.80
Niarriage Kit $2.10
Notary Embosser tn,L tilti.tl.olar alaitili! o, i,E)$28.50 $2. t4
Rectangular Mobile Stamp t'l0,,,.r sr, r l;p .. r,: ,.0 ior r $25.50 $1.91
Displry Sign rr,l li:r,r,r f .i'i,:, ,t nii!1,1.. r,rli,L )$ l -s.00 $ r.l3
Americao Society of Notaries onc Yea-r M€mbership $39.00 N/A
Florida Notary Handbook sr2.7s $.e6
Shipping & Handling $7.00
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4YEAR ERRoRs & OMrsstoNs Polrcrls
PRoDtrcr D[scRIpfloN PRrcE + TA)(* = SUBToTAT
Ft'47 (Bl2t) Mail Application, Order Form and Payrnent to: Notary Public Underwriters, Inc. . P.O. Box 5378 . Tallahassee, FL 32314-537g
P-514
Rectangular Mobile Stamp
F,rpirs:
$1.80
ADrlrTroNAL Stlppr Its
$.7s
$28.00
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NOTARY PUBLIC COMMISSION APPLICATION
Florida Depadment of State
Notary Commissions and Certifications Section (850) 245-697 5
Mail Applic€tions tor j\-otar tltlil
ll[0tnlj]RtTtn, tn(
PO 8ox 5378
Taflahass€e, FL 32314-5378
800.821.082.|
PERSONAL INFORMATION
Full Legal Name ?or^.o.A
lMiddle)
(county) llp)
E Unemployed tr Retired
(Lasr)
Home Address
Place of Employment:
(Srreet)(CilY)(Slslol
(Sred)
Mailto: E Home! Business E Ottrer Address
Business Address:
E-t\rail Address:
Home Phone
(City)(County)lzip)
SlreeUP.O. Box (City)(Sleiel (Z p)
Race: E Asian
E Black or Aftican American
E Native Arnerican orAlaska Nalive
{rann"
(or wtjte'NONE )
Sex: E Male
Iremate&5!{r 9te,#=#$fa
aa!L,qAY;,k#S
Social Security Number:58q - IeA-t{ r 3'l
The disdosure of a Florida notary public appliEnt's social security number is expressly required by Fh. Stat. S117.01(2) and is impeEtive for processing notary public
commission applicalions. Please be advised that social secudty numbels are only used foa processing the notary applicalion aM are exempt from disclosure pursuant
to Fla. Stat. 5119.071(5Xa)5.
1 . Are you a legal resident of FloridaZ ['Ves E No (lf l,lo, pu are not eligible to apply for a notary commission. Legal residencl must b€ maintained lhroughout $e
appdntrnent)
2. Are you a United States cit2enZ [Yes E No 1lf No, you rnust submil a recorded Dedaration ol Domicile. Obtain tris doo]rnent tom your county courthouse.)
3. Are you a wartime veteran with a'disability rating of 50 percent or more? EYes ff{o 1f vo, pt, *rst subn* a r/ritten request for the tee rcducrion and
provide prmf of ex€mptbn.)
4. Are you now
education murs€
or have you ever been commissioned a Notary Public in
a signed certjfcate of mmpletion. tu. Stat 5668.50 (1 1 )(b).) Go to
E No 1[ No, you must mmplete a 3 hour mhry
to complete t|e notary course,
lfYes:
5. Have
(lf Yes,
Have
aa. eA 185 olL
Business Phone E other:
Florida Driveds License (oi other state of Ftorila tssued tD)PabLi,El-18{oL{-o Date of Birth
date)(Commissio{ numbed (Name n which yourcommis3ion wasissusd)
6. Have yogpeen disciplined by a regulatory agency, including The Florida Bar, and including disciplinary action that is confidential?
U Yes [{No (lf Yes. you mrst submit a witten statement about the nature of the ac{on and any supMng dodmenlatjon, sudr as a mpy of ttE Final Order trom the regulatirE
agenry.)
7. Have you_leen convicted of a felony or have you had an adjudication of guilt withheld for a felony ofense?
trYes [No (lfYes, you musl submit a written statement o, he natJre of he offense(s), a mpy ofhe murtjudgment and sefltencing order lfconvicted, you must submit a
cedficate d[ ReitoraliM of Civil Rhhts.)
8. Are you cunently on probation? tr Yes ,(No
STATE OF tr\vi .t.-\orflC(Ct l)r.rrn'y^tc
AFFIDAVIT OF CHARACTER
am unrelated to and have known Cre'rru
?
lSrate)
,?rt)t^-Y (J County
Cr(O
for one year or
My address is
(Prinl or Type l.lame ol Afr.nt)
more; and to the of my knowledge and observation know hi
rqqo A
(Slreell (City)
(Name otApplicant)
UNDER PENALTY OF PERJURY I DECLARE THAT I HAVE READ THE FOREGOING AFFIDAVTT AND THAT
(z p)
IT ARE TRUE
Home nnone:1?$l ;
,da-w1z
FL,Ol
(or wrilo'NONE )
wo* enonel 1$1, TlhkoH8o
FACTS
AmantJ
P-514
Extension 3b6t
I,
or her to be of good characler,
I
STATE OF FLORIDA
UNDER
L
ldo.solemnly swear (or aflirm) that lwillsupport, protect, and defend_the constjtution and Govemment of the united states and of the state ofFlorida; that lam dulv qualifiei! to hold offcb'unddr tire Constitution or tt'e stae; rril in'iJ"r.eii Cltapter rrz, Florida statutes, and anyamendments therelo, and know the duties, responsibilities, ljmitations, ano poiners or ilola-,y pr-driiii^a tiiii r'iJiii*"ri-aio?iiltJrri'perform theduties of Notary Pubtic, state of Frorida, ori which I am now ioouiio ehter. 5o neip me Gd./ ---''
County
'Note: It you afiirm. you may omit the words
"So help me God.' Fla. Stat. 592.52.
RY IDECLARE THAT I HAVE READ THE FOREGOING APP LICATION AND OATH, AND THAT THE FACTSaccept the Ofiice of Notary public, State of Florida
x
-)
oftic giaiur€ oflpp,icant)
lPrint or Type l{ame. Qam for which your.omhlssion urittbe issued no inltiai.
Jorathan Davrd Doe. Jofl D. 0o?. Jonathan Doe, Jo;athan D. Doe
EREIN
MEMORANDUM
ASAGENERAL MATTER, APPLICATIONS FORALL POSITIONS WTHIN STATE GOVERNMENTARE PUBLIC RECORDS, WHICH MAY BEVIEWED BYANYONE UPON REQUEST. HOWEVER, THERE ARE SOME EXEMPTIONS FROM THE PUBLIC RECORDS LAW FORIDENTIFYING INFORMATION RELATING TO SOCIAL SECURITY NUMBERS, PASTAND PRESENT LAW ENFORCEMENT OFFICERS ANDTHEIR FAMILIES, VICTIMS OF CERTAIN CRIMES, ETC. IF YOU BELIEVE AN EXEMPTION FROM THE PUBLIC RECORDS LAWAPPLIES TOYOUR FLORIDA NOTARY PUBLIC COMMISSION APPLICATION SUBMISSION, PLEASE CHECK THE FOLLOWING BOX:
El Yes, I assert that identifi/ing information.provideo_ !n t[s apq[cation (o]fier than my social searfi number, whicfr l'am aware is automaticalyexempt from public disclosure, pursuant to Fla. Stat. Sl'19.071) should te excluoira ftom inspeciion undei public Remrds Law.
lf Yes, please indicate what section of Florida Statues provides this exemptlon. lf you are unsure of the Florida Statute, use the llnkbelow to download and complete the public Records Exemption Reiuest forms:
https ://dos. myfl orida.com/media/695951 /dosl 1 9.pdf
2
OATH OF OFFICE
or,[,!#*|,*oar
The DOS Public Records Exemption Request forms are to act as a guide to assist applicants and does not have to be submitted ifbox is not checked.
STATE OF FLORIDA
KNOWALL MEN BYTHESE PRESENTS, Thatwe,
as Principal, and
(Name ot Applicant)
Universal S urety of America (800) 331-6053 as Surety Company, give bond payable to any
lmprint Name ot Surety Company
individual who may be harmed as a result of a breach of duty by said applicant acting in his/her official capacity as Notary
Public, in the amount of Seven Thousand Five Hundred Dollars ($7,500) as assurance for the due discharge of the duties
of his/her office of Notary Public and we do bind ourselves, and each of our heirs, executors and administrators, jointly
and severally.
STATE OF FLORIDA
BOND OF NOTARY PUBLIC
Secretary of State
Notary Commissions
NoW therefore, if said applicant shall faithfully discharg
then this obligation shall be void-
e the duti ry Public, as prescribed by law,
x
(Signature OtAppllcant)
UNIVERSAL SURETY OF AMERICA
(Name of Surety Company)
P. O. BOX 5077
Sioux Falls sD 57117-5077
(Addr6ss ol Surety Company)
NOTARY PUBLIC UNDERWRITERS
(Name of BondingAgency or Company)
P. O. Box 5378
Tallahassee FL 32314-5378
(A('dress of Bonding Agencl or Company)
(Signature of Florida Licensed Agent)
A068326
(Flodda Liconsed Ag6nt Number)
JACK DIESTELHORST
(ftinted Name of Flcrjda Licens€d Aaent)
Section 817.234(1 Xb), F.S. "Any person who knowingly and with intent to iniure, defraud, or deceive any insurer files a
statement of claim or an application containing any false, incomplete, or misleading information is guitty of a felony in the
third degree."
This bond shall be for Seven Thousand, Five Hundred Dollars ($7,500). After execution by surety company, the bond
must be submitted to the Department of State for approval and filing before issuance of the notary public mmmission,
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=lSrnl!=z"B,fi,N
FL{2 DS/DE (03/04)
SURETY BONO
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FOR OFFICE USE ONLY
Approved by Department of Slate:
Applicant was, on the date of issuance of commission, bonded as a Notary Public in and for the State of Florida, to hold
office for the term of four years in accordance with the Constitution and Laws of this State.
Signed and sealed this day of
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By
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SURETY BOND
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