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Florida Notarial Certificate – Oath or Affirmation of Individual With Disability

The Florida notarial certificate (oath or affirmation of an individual with a disability) is used by a notary public to notarize an affidavit completed by an individual incapable of signing on their own. By executing this notarial certificate, the notary verifies that the individual personally appeared before them, confirmed their identity, and attested to the accuracy of the statements in the affidavit. Two (2) disinterested witnesses must be present when the disabled party directs the notary to sign on their behalf. Additionally, the two (2) witnesses must inscribe their names, addresses, and signatures on the notarial certificate.

After the affidavit is signed and the two (2) witnesses have provided the requisite information on the notarial certificate, the notary will fill out the remainder of the certificate to officially notarize the affidavit.

Laws – § 117.05(14)




_______________________________         _______________________________
Printed Name and Address of Witness          Signature of Witness

_______________________________         _______________________________
Printed Name and Address of Witness          Signature of Witness


Signature Affixed by Notary, Pursuant
to § 117.05(14), Florida Statutes


COUNTY OF _________________


Sworn to (or affirmed) and subscribed before me by means of ☐ physical presence ☐ online notarization, this ___ day of _________________, 20___, by _________________ (Name of Person with Disability), and subscribed by (Name of Designated Person) in the presence of _______________________________ (Names of Witnesses) at the direction of _________________ (Name of Person with Disability).


Signature of Notary Public

Print, Type or Stamp Name of Notary

Personally Known: ____
OR Produced Identification: ____
Type of Identification Produced: _________________