I. Applicant Information

Full Legal Name: [Your Name]

Residential Address: [Your Company Address]

City, State, Zip Code: [City], [State], [Zip Code]

Email: [Your Company Email]

Phone Number: [Your Company Number]

II. Employer Information (if applicable)

Company Name: [Company Name]

Company Address: [Company Address]

City, State, Zip Code: [City], [State], [Zip Code]

Company Phone Number: [Company Phone Number]

III. Notary Public Information

Name for Commission: [Your Name's Commission]
Commission Number (if applicable): [Your Commission Number]
Commission Expiration Date: [Your Commission Expiration Date]
Date of Appointment: [Date of Appointment]
Bond Amount: [Bond Amount]

IV. Professional References

1. Reference Name 1: [Reference Name 1]

   • Contact Information: [Contact Information]

2. Reference Name 2: [Reference Name 2]

   • Contact Information: [Contact Information]

3. Reference Name 3: [Reference Name 3]

   • Contact Information: [Contact Information]

V. Oath of Office

"I, [Your Name], do solemnly swear (or affirm) that I will support, protect, and defend the constitution and government of the United States and of the state of [Your State], that I am duly qualified to hold office under the constitution and that I will well and faithfully perform the duties of Notary Public of the state of [Your State] on which I am now about to enter."

Date: [Current Date]

VI. Affirmation

"I, [Your Name], understand that providing false information on this application may result in criminal conviction and revocation of my notary public commission.”

Date: [Current Date]

VII. Submission

Please submit this application alongside a copy of valid identification to the [Your State’s Notary Commission Office Address]

[City, State, Zip Code]

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