DFS-A4 Form PDF Details

In the complex landscape of legal formalities, the DFS A4 form occupies a critical role, primarily employed as a Notarized Sworn Statement of the Claimant. This document serves as a fundamental instrument through which individuals affirm the validity of their statements under oath, a process meticulously detailed within its framework. Designed for the explicit purpose of legitimizing claims through the claimant's sworn testimony, the form necessitates the provision of essential personal information, including the claimant's full name, current address, and date of birth. The completion and submission of this document follow a structured format where the claimant's declaration is formally acknowledged in the presence of a notary public. This affirmation occurs on a specified date and involves a comprehensive verification of the claimant’s identity, requiring the presentation of government-issued photographic identification. The procedural specifics are pivotal, not only for the integrity of the document but also for ensuring adherence to the legal statutes encapsulated in Section 717.124(1), FS, thereby embedding the form within the broader regulations of the Florida Administrative Code. Given its legal significance and the strict requirements for completion, understanding the DFS A4 form is indispensable for individuals navigating claims processes, ensuring that their sworn statements hold the necessary legal standing.

QuestionAnswer
Form Name DFS-A4 Form
Form Length 1 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 15 sec
Other names florida form dfs a4 2007, 2007 form a4, dfs a4 form, dfs a4

Form Preview Example

NOTARIZED SWORN STATEMENT OF THE CLAIMANT

Claim Number _________________

After being duly sworn, the affiant states as follows:

1.My full name is ___________________________________.

2.My current address is ____________________________________________

Street Address

______________________________________________________________

City

County

State ZIP Code

3.My date of birth is: month ___________________, date_________, year____________

___________________________

Signature of Affiant

STATE OF

)

COUNTY OF

)

Sworn to and subscribed before me this_________ , day of

___________, _____, by _________________________________.

(Month)

(Year)

(Name of person making statement)

__________________________________

(Signature of Notary Public)

_________________________________________________________

(Print, Type, or Stamp Commissioned Name of Notary Public)

______________________________________________________________

Address of Notary

______________________________________________________________

City

County

State ZIP Code

*Notary must identify the type of government issued photographic identification produced that verifies Affiant’s name and date of birth as stated on this form above.

Type of identification shown to Notary by Affiant (such as a drivers license, state identification card, passport, or other similar valid government issued photographic identification): ________________________________

*Pursuant to Section 717.124(1), FS, the claimant must produce to the notary photographic identification of the claimant issued by the United States, a state or territory of the United States, a foreign nation, or a political subdivision or agency thereof.

Form DFS-A4-2007, Effective 10-13-10, incorporated into Rule 69I-20.0022, F.A.C.

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