Follow the steps to complete the Doctor Verification Affidavit

1. Click ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. In the first blank space, enter your name as the applicant. Ensure the spelling is accurate for official documentation.
3. Fill in the name of the facility where you will be working in the corresponding section. This is crucial for proper identification.
4. Provide the facility's complete address, including street, city (Hialeah), and zip code in the designated fields.
5. Record your State License number in the next line, followed by its expiration date. This information verifies your professional credentials.
6. Input your Driver’s License number and its expiration date in the subsequent fields. This offers additional identification verification.
7. Acknowledge that you will inform the Business Tax Receipt Division in writing when you stop working at the listed location.
8. Sign the affidavit in the designated area to confirm the information provided is accurate to the best of your knowledge.
9. Insert the date of signing, ensuring your signature is dated correctly.
10. Leave the Notary section for the official to fill out; ensure you have a valid ID ready for the notarization process.
11. Once all fields are filled out, review the document for accuracy. You can then save any changes, download the form, print it, or share it as needed.

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