Form DS-DE77A "Amended Commission Request Notice of Name Change" - Florida

What Is Form DS-DE77A?

This is a legal form that was released by the Florida Department of State (Secretary of State) - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2003;
  • The latest edition provided by the Florida Department of State (Secretary of State);
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DS-DE77A by clicking the link below or browse more documents and templates provided by the Florida Department of State (Secretary of State).

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Download Form DS-DE77A "Amended Commission Request Notice of Name Change" - Florida

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AMENDED COMMISSION REQUEST
NOTICE OF NAME CHANGE
_______________________________________________
______/ ______/ ______
Type or print name in which commission is currently issued
Date of Birth
_______________________________________________
Sign your official signature as currently commissioned
________________________________________________
Imprint current seal for identification only
Type or print new commission name as it is to appear on your
Certificate
_______________________________________________
______/ ______/ ______
Sign your new official signature, the same as your new
Date legal name changed
commission name
FILL IN YOUR CURRENT ADDRESSES AND PHONE NUMBERS:
_________________________________________________________
(______) __________________
Physical home address, City and Zip
Area code and telephone number
_________________________________________________________
Indicate business name, unemployed or retired
_________________________________________________________
(______) __________________
Business address, City and State
Area code and business telephone no.
MAIL TO:
Business
Home
OR _________________________________________________
Mailing address
Please forward this form along with applicable fees and your current commission to your bonding agency.
Your bonding agency will provide the rider to your notary public bond and forward all forms to the Secretary
of State's office for processing.
DS-DE 77A (11/03)
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AMENDED COMMISSION REQUEST
NOTICE OF NAME CHANGE
_______________________________________________
______/ ______/ ______
Type or print name in which commission is currently issued
Date of Birth
_______________________________________________
Sign your official signature as currently commissioned
________________________________________________
Imprint current seal for identification only
Type or print new commission name as it is to appear on your
Certificate
_______________________________________________
______/ ______/ ______
Sign your new official signature, the same as your new
Date legal name changed
commission name
FILL IN YOUR CURRENT ADDRESSES AND PHONE NUMBERS:
_________________________________________________________
(______) __________________
Physical home address, City and Zip
Area code and telephone number
_________________________________________________________
Indicate business name, unemployed or retired
_________________________________________________________
(______) __________________
Business address, City and State
Area code and business telephone no.
MAIL TO:
Business
Home
OR _________________________________________________
Mailing address
Please forward this form along with applicable fees and your current commission to your bonding agency.
Your bonding agency will provide the rider to your notary public bond and forward all forms to the Secretary
of State's office for processing.
DS-DE 77A (11/03)