NAME OF NEWSPAPER

Published (Weekly or Daily)

(Town or City) (County) FLORIDA

STATE OF FLORIDA

COUNTY OF ____:

Before the undersigned authority personally appeared ____, who on oath says that he or she is ____ of the ____, a ____ newspaper published at ____ in ____ County, Florida; that the attached copy of advertisement, being a ____ in the matter of ____ in the ____ Court, was published in said newspaper in the issues of ____.

Affiant further says that the said ____ is a newspaper published at ____, in said ____ County, Florida, and that the said newspaper has heretofore been continuously published in said ____ County, Florida, each ____ and has been entered as periodicals matter at the post office in ____, in said ____ County, Florida, for a period of 1 year next preceding the first publication of the attached copy of advertisement; and affiant further says that he or she has neither paid nor promised any person, firm or corporation any discount, rebate, commission or refund for the purpose of securing this advertisement for publication in the said newspaper.

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)