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Notary Public Change Or Amendment To Application - Iowa
| Notary Public Change Or Amendment To Application Form. This is a Iowa form and can be used in Notaries Secretary Of State . |
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MATT SCHULTZ Secretary of State State of Iowa Notary Public Change/Amendment to Application PRINT THE FOLLOWING INFORMATION AS IT APPEARS IN OUR SYSTEM: Name (as it appears on your certificate) __________________________________________________________________________ Address _____________________________________________________________________________________________ Address City State Zip Date Commission Expires: _____________________ Commission No: (found on your certificate) ____________________________ SECTION 1, COMPLETE ONLY IF IT APPLIES. SECTIONS 2 - 4 MUST BE COMPLETED SO THE INFORMATION CAN BE CHANGED/VERIFIED ON OUR RECORDS. 1. CHANGE OF NAME (if applicable) I hereby request that the Secretary of State amend my notary commission by changing my name on my notary commission to: _________________________________________________________ effective _____________________________ New Name (print) Date I understand and agree that by notifying the Secretary of State of my name change I will use my new name when notarizing documents beginning on the effective date shown above through the end of my term. 2. HOME ADDRESS and PHONE (must complete) The Secretary of State must have this information to change/verify it on the Notary's Commission. ______________________________________________________________________________________________ Address (including P.O. Box if applicable) City State ZIP _____________________________________ ______________________________________________________ Home Phone Home E-mail Address 3. EMPLOYER NAME, ADDRESS and PHONE (must complete) The Secretary of State must have this information to change/verify it on the Notary's Commission. Employer Name ______________________________________________________ Address (including P.O. Box if applicable) City ____________________________________ Employer Phone State ZIP ______________________________________________________________________________________________ ______________________________________________________________________________________________ Work E-mail Address 4. ADDRESS DESIGNATION (must complete) Check the box to indicate which address you wish to designate for mailing purposes. If no address specified, home address will be designated. Home Business If you have provided business contact information different from your home information, you may opt to shield your home address, phone number and e-mail from display on the Secretary of State's website. Would you like to exercise this option? Yes No I understand that I must be a resident of Iowa or a resident of a state bordering Iowa and work in Iowa to qualify as an Iowa notary. Signature ______________________________________________________ SECRETARY OF STATE Notary Public Clerk Lucas Building, 1st Floor Des Moines, IA 50319 Phone: (515) 281-5204 FAX: (515) 242-5953 rev 12/11 Date _______________________ Website: sos.iowa.gov American LegalNet, Inc. www.FormsWorkFlow.com
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