Notary Public Application

NOTARY PUBLIC APPLICATION

This Notary Public Application is submitted by Applicant Name: and is presented to Commissioning Authority: for the purpose of requesting commission as a Notary Public under applicable law and regulations.

RECITALS

WHEREAS, the Applicant seeks appointment and commission as a Notary Public to perform notarial acts in the jurisdiction of the Commissioning Authority; and

WHEREAS, the Applicant affirms eligibility to serve as a Notary Public and acknowledges the statutory requirements, bond and recordkeeping obligations applicable to the office; and

WHEREAS, the Commissioning Authority requires this written application, affirmation under penalty of perjury, and any supporting documents or bond instruments prior to issuance of a commission;

NOW, THEREFORE, in consideration of the matters set forth herein and subject to approval by the Commissioning Authority, the Applicant submits this application and certifies the statements contained below are true and complete.

1. APPLICANT INFORMATION

Date of Birth:

2. ELIGIBILITY, OATH AND QUALIFICATION

The Applicant affirms under penalty of perjury that Applicant meets all statutory qualifications to be commissioned as a Notary Public, including but not limited to residence or place of employment within the jurisdiction, minimum age requirement, and absence of disqualifying felony convictions not restored by law.

Applicant hereby declares and swears that the statements and answers contained in this application are true and complete, and that Applicant will faithfully discharge the duties of the office of Notary Public in accordance with law if commissioned.

3. BACKGROUND AND CRIMINAL HISTORY

Have you ever been convicted of a felony, or any crime that would disqualify you from serving as a Notary Public? No Yes

Applicant consents to criminal background checks, fingerprinting, and verification of records as required by the Commissioning Authority for processing this application. I consent

4. BOND, INSURANCE AND RECORDS

Applicant acknowledges that issuance of a commission may require a surety bond and/or liability insurance as a condition of commissioning. If a bond is required, identify bond details below.

Bond Effective Date:

5. FEES AND PAYMENT

Payment method: Check Money Order Other

6. CERTIFICATION AND ACKNOWLEDGMENTS

By signing below, Applicant certifies under penalty of perjury that all statements in this application are true and complete. Applicant understands that making a false statement may be grounds for denial, revocation of a commission, and subject to criminal penalties including prosecution for perjury.

Applicant agrees to comply with statutory duties of a Notary Public, including maintaining a journal of notarial acts when required, safeguarding the official seal, notifying the Commissioning Authority of any change of name or address, and executing and delivering any required bond and oath prior to commissioning.

7. AUTHORIZATION FOR BACKGROUND CHECK

Applicant authorizes the Commissioning Authority and its agents to obtain criminal history information, court records, and other information necessary to evaluate eligibility. Applicant further acknowledges that information obtained may be used in assessing suitability for commission and may be retained in official records.

Applicant authorizes release of such records and waives any claim for invasion of privacy or violation of confidentiality arising from the lawful collection and use of such information. Authorized

8. NOTICES

All official correspondence and the commission certificate, if issued, should be mailed to:

9. ADMINISTRATIVE PROVISIONS

Governing Law: This application, any commission issued, and the Applicant's duties as a Notary Public shall be governed by the laws of the jurisdiction of the Commissioning Authority.

Entire Agreement: This application contains the entire understanding between the Applicant and the Commissioning Authority regarding the subject matter hereof and supersedes any prior statements or representations, whether oral or written.

Severability: If any provision of this application is held invalid or unenforceable, the remaining provisions shall continue in full force and effect.

Amendments; Waiver: Any amendment or waiver of the provisions of this application shall be in writing and executed by the Applicant and an authorized representative of the Commissioning Authority.

Counterparts: This application may be executed in counterparts, each of which shall be an original and all of which together shall constitute one and the same instrument.

10. ATTACHMENTS

The Applicant shall attach hereto any required documents including a copy of valid identification, required bond instrument, fee payment receipt, and any supplemental declarations. List of attachments:

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