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Pursuant to S.C. Code of Laws 24726-1-140(B), when a notary ceases to reside in South Carolina or becomes permanently unable to perform his or her duties, the notary shall resign his or her commission and notify the Secretary of State of the resignation using the Change in Status Form. Please type or print in black or blue ink. (name as commissioned) (effective date of resignation) In the presence of a notary, please sign your name as printed above. Please sign here using your name as commissioned. American LegalNet, Inc. www.FormsWorkFlow.com