The Florida notary acknowledgement for an individual with a disability is used to verify the signature provided by a person who is physically unable to sign. It proves that the individual willfully executed a document with a complete understanding of the consequences of signing. Due to the limitations of the disabled individual, a notary public will act as the designated signer and give their signature on the individual’s behalf. The notary must sign in the presence of both the disabled individual and two (2) disinterested witnesses. Once signed, the notary will complete the acknowledgement certificate to confirm the signature.

Note: If the notary does not know of the individual’s identity from personal knowledge, a satisfactory form of identification must be produced.

Laws – § 117.05(14)

FLORIDA NOTARY ACKNOWLEDGEMENT

(INDIVIDUAL WITH A DISABILITY)

 

_______________________________         _______________________________
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

 

STATE OF FLORIDA
COUNTY OF _________________

 

The foregoing instrument was acknowledged 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).

(Seal)

_______________________________
Signature of Notary Public

_______________________________
Print, Type or Stamp Name of Notary

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