DFS-A4 Form – Fill Out and Use This PDF

Updated: Nov 10, 2026

The agency issues this form itself. The issuer's site (flrules.org) says: "This form is incorporated by reference effective 10-13-10 and available from the Florida Department of Financial Services, Division of Unclaimed Property, 200 East Gaines Street, Tallahassee, Florida 32399-0358, floridaunclaimedproperty@myfloridacfo.com". The copy on this page is kept for reference. Ask the issuer for it. Checked October 11, 2026.

The DFS A4 form is a notarized sworn statement required from claimants in certain legal or administrative processes, providing essential personal information and attesting to the truth of the claims made. This document must include the claimant's full name, current address, and date of birth, and it needs to be signed in the presence of a notary public, who verifies the claimant's identity through acceptable government-issued photographic identification. For those needing to complete this important step, please consider the ease of clicking the button below to fill out your form.

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How to Fill Out Form DFS-A4-2007

Form DFS-A4-2007 at a glance

What it is: Form DFS-A4-2007 is the Notarized Sworn Statement of the Claimant.

Who signs: Two signatures are on the form: the Signature of Affiant and the Signature of Notary Public.

A filled-in Form DFS-A4-2007 example: a claimant signs before a notary

Form DFS-A4-2007 example filled out, example: a claimant signs before a notary — Maria Sample, a claimant, signs the sworn statement before a notary. She gives her claim number, address and date of birth, and the notary completes the notary lines. The picture shows the whole page and all its values are invented.

How to fill out Form DFS-A4-2007, box by box

Claim Number

Enter the Claim Number at the top of the form.

My full name, current address and date of birth

After being duly sworn, the affiant states as follows: My full name is the name you enter.

Enter your current address: the Street Address, City, County, State and ZIP Code.

Enter your date of birth as the month, the date and the year.

Signature of Affiant

Sign on the line marked Signature of Affiant.

STATE OF, COUNTY OF and Sworn to and subscribed before me

The notary writes the STATE OF and the COUNTY OF where the statement is sworn.

The notary writes in: Sworn to and subscribed before me this day of the month and the year, by the name of the person making the statement.

Signature of Notary Public and Address of Notary

The notary signs on the line marked Signature of Notary Public and prints, types or stamps the Commissioned Name of Notary Public.

The notary enters the Address of Notary: the City, County, State and ZIP Code.

Type of identification shown to Notary by Affiant

The notary must identify the type of government issued photographic identification produced that verifies the affiant's name and date of birth as stated on this form.

Type of identification shown to the notary by the 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.

More rules for Form DFS-A4-2007

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

Sources

[1] Form DFS-A4-2007 (Effective 10-13-10), Notarized Sworn Statement of the Claimant (the Official source link on this page).

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.

Question	Answer
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