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P. O. Box 5077 · Tallahassee, FL 32314-5077 800.385.7019 or 850.224.3156 www.troyfain.com

Lost/Stolen Seal Notification

In accordance with the provision of F.S. 117.05(d), I , the undersigned, hereby notify the Department of State and the Governor that: (check the appropriate response and provide an explanation) My seal has been stolen and has not been reported to law enforcement authorities. My seal has been stolen and has been reported to law enforcement authorities. I believe my seal to be in the possession of another person. My seal has been lost.

This information is true and correct to the best of my knowledge.

X_________________________________________________

Sign as your name appears on your commission

Date __________________________________ Date of Birth ________ / ________ / ________ Expiration Date _______ / _______ / ________

_________________________________________________

Print as your name appears on your commission

Commission Number __________________________________

If you are ordering a seal, mail or fax your notice to Troy Fain and we will deliver it to the State. For your convenience our fax number is 1-850-224-5253. If you prefer to mail your notice directly to the State, please send it to the following address: Department of State, Division of Corporations Notary Commissions and Certifications Section P. O. Box 6327 Tallahassee, FL 32314

TF-04 (02/09)

Serving Florida Notaries Since 1949

P-9

O RDER F ORM

Rectangular Self-Inking Stamp - $16.00

This self-inking stamp from Trodat® produces quality impressions without using a stamp pad. Now available in six colors! Please select your favorite below. To view the color options, please visit www.troyfain.com. Grey (Default) Mint Mango Blue Red Pink

Round Self-Inking Stamp - $20.00

This round self-inking stamp produces clear impressions similar in format to a metal embosser. No need for a separate ink pad.

W I T NE S S

ES IR 2 1 20

A IM

MY C DE C E

SI O MIS N EX OM MBER 31, P

#

#

IDA

Round Stamp Image not actual size.

COMMISSIONED NAME Commission # EE123456 Expires September 31, 2012

Bonded Thru Troy Fain Insurance 800-385-7019

#DD 123456

OR

Tr Bond hru oy ed t Fain Insurance

Y AR NOT

Rectangular Stamp Image not actual size.

PU L FF BLIC , STATE O

Travel Stamp - $21.00

Designed for notaries who are always on the go, this portable self-inking stamp is a great addition to your regular notary stamp. Please select your favorite below. To view the color options, please visit www.troyfain.com. Silver (Default) Blue Red Green

Round Industrial Self-Inking Stamp - $36.00

Perfect for numerous notarizations, this high quality stamp is built to last.

Notary Public Record Book - $10.00 Errors and Omissions Insurance You Are Unprotected!

If you did not purchase a policy with your commission, call us today. Keep a log of your notarial acts with this record book. With room for 248 entries, thumbprint space, and simple step-by-step instructions, this journal complies with all recommendations of the Governor's Office.

Description Rectangular Self-Inking Stamp Travel Stamp Round Self-Inking Stamp Round Industrial Self-Inking Stamp Notary Public Record Book Embossing Seal American Society of Notaries Display Sign Shipping & Handling

Amount $16.00 $21.00 $20.00 $36.00 $10.00 $15.00 $39.00 $12.00

Tax $1.20 $1.58 $1.50 $2.70 $0.75 $1.13 n/a $0.90

Subtotal

American Society of Notaries Membership - $39.00

Become a member of the oldest national nonprofit association for notaries public in the United States. Enjoy a toll-free hotline, monthly email tips, newsletters, and more.

Embossing Seal - $15.00

This hand-held seal comes with its own carrying case. Although not an official notary seal, its raised impression is well-recognized and can be used in conjunction with your regular notary stamp.

$5.00

Display Sign - $12.00

Let everyone know that you are a notary with this black and silver personalized sign.

Total

PAYMENT INFORMATION

Check/Money Order Payable to: TROY FAIN INSURANCE Card Number Billing Address for Card Address

-

-

Expiration

City

/

Security Code

State Zip

Authorized Signature of Cardholder

Daytime Number (

)

P. O. Box 5077 · Tallahassee, FL 32314-5077 · 800.385.7019

P-9

Information

TF-04

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