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AFFIDAVIT OF CONFISCATION OF IDENTIFICATION

STATE OF FLORIDA COUNTY OF __________________

Under the penalties of perjury, I declare that the person appearing before ____________________________, a Notary Public, is personally

known to me as:

_____________________________________________ and is the person named in the document(s) requiring notarization; and that the forms of identification acceptable by Florida Statute, for the above named inmate of an institution of confinement were confiscated upon confinement.

_______________ Date

____________________________________ Signature of Law Enforcement Officer

_______________ ID Number

____________________________________ Printed Name of Law Enforcement Officer

Sworn to (or affirmed) and subscribed before me this

________

day of

________________

,20

____

,

by the above named Law Enforcement Officer, who provided (check one) F a Drivers License or

F _______________________________________________________________ as identification.

_____________________________________ (Signature of Notary Public)

_____________________________________ (Printed name of Notary Public)

My commission expires:

_________________

PAW Notary Services – Affidavit Of Confiscation Of Identification – Prepared pursuant to Section 117.05(5)(b)2.h Florida Statutes (2001)

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