Florida/Georgia Personal Injury & Workers Compensation

NAME OF COUNTY

STATE OF FLORIDA

COUNTY OF  

Before the undersigned authority personally appeared  , who on oath says that he or she is   of   County, Florida; that the attached copy of advertisement, being a   in the matter of   in the   Court, was published on the publicly accessible website of   County, Florida, or in a newspaper by print in the issues of   on   (date)  .

Affiant further says that the website or newspaper complies with all legal requirements for publication in chapter 50, Florida Statutes.

Sworn to and subscribed before me this   day of  ,   (year)  , by  , who is personally known to me or who has produced   (type of identification)   as identification.

  (Signature of Notary Public)  

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

  (Notary Public)