Application for Notary Public Change of Name
I. Applicant Information
Full Name: [Your Name]
Previous Name: [Previous Name]
New Name: [New Name]
Date of Birth: [Date of Birth]
Email Address: [Your Email]
II. Reason for Name Change
[Provide a detailed explanation for the name change]
III. Verification of Identity
Primary Identification Document:
Type: [Type of Identification Document]
Number: [Identification Number]
Issuing Authority: [Issuing Authority]
Expiry Date: [Expiry Date]
Secondary Identification Document (if applicable):
Type: [Type of Identification Document]
Number: [Identification Number]
Issuing Authority: [Issuing Authority]
Expiry Date: [Expiry Date]
IV. Acknowledgment of Application
I, [Your Name], hereby declare that the information provided above is true and accurate to the best of my knowledge.
V. Notary Public Details
Current Notary Public Name: [Current Notary Public Name]
Notary Commission Number: [Notary Commission Number]
State of Commission: [State of Commission]
Expiry Date of Commission: [Expiry Date of Commission]
VI. Signature
[Your Name] (Printed Name):
Date of Sign: (Date of Sign):
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