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Application For Reappointment As A North Carolina Notary Public - North Carolina
| Application For Reappointment As A North Carolina Notary Public Form. This is a North Carolina form and can be used in Notary Secretary Of State . |
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State of North Carolina Department of the Secretary of State Elaine F. Marshall, Secretary of State Class in lieu of on-line re-commission exam Application for failure to take oath Notary Instructor APPLICATION FOR REAPPOINTMENT AS A NORTH CAROLINA NOTARY PUBLIC (Revised Sept 2010) Read the instructions completely before filling out this application. Please print in black ink or type answers. 1. Applicant's Full Legal Name (Full name with no initials) 2. Applicant's Commission Name* Gender: M F Reappointment Applicants Place Current Notary Seal Here Do not purchase a new seal until you take the new oath ___________________________________________________________________________________ ___________________________________________________________________________________ *You may use one initial for the first or middle name but not for both. Commission name may be a part of your full legal name, but not a nickname or shortened version of your legal name. No single initials without a full first or middle name are permitted. This name is how you will be commissioned and must appear exactly as such on your seal. 3. Name on Last Commission / Expiration Date / County City: City: Fax: State: State: 6. Are you a citizen of the United States? 9. Birth Date: Zip: Zip: Yes No 4. Mailing Address: Residence Address if Different: 5. Business Phone + ext: 7. Social Security #: Home Phone: 8. E-Mail Address: If No, attach a copy of your Permanent Resident Card (Form I-551). 10. County of Residence: 11. Occupation: _________________________________ OR Unemployed Retired Student Self-Employed Business / Employer: ___________________________________ County Where Employed: ___________________ Business Mailing Address: (Address,City,State,Zip) 12. Have you completed a notary public education course? Yes No Number of Class Hours: ____ _______________________________ ________________________________ ____________ name of educational organization or community college print or type name of instructor date completed I hereby certify that the above named applicant has successfully completed the notary public education course and therefore qualifies for your consideration for a notary public commission. ______________________________________ ____________ (Signature of instructor is required for applicants who take the course prior to reappointment ) signature of instructor date signed 13. Were you commissioned on or before July 10, 1991? Yes No Initial appointment date (if known) _______/_______/_______ If Yes, has your commission been continuous since your initial appointment? Yes No Have you ever had a disciplinary action from the Secretary of State's office against your commission? Yes No 14. Are you a licensed member of the North Carolina State Bar? 15. Do you have a current Notary Public Guidebook for NC? Yes No Yes No If yes: Year Edition 16. Have you ever been convicted by any court of a felony or misdemeanor? Have you been charged with an offense for which trial is still pending? Yes No If yes to either question, see instructions on following page. 17. Have you ever had a professional license or notary commission denied, revoked, restricted or suspended? Have you ever had to resign a license or commission under unfavorable circumstances? Yes No If yes to either question, see instructions on following page. 18. I, ____________________________________________, solemnly swear or affirm under penalty of perjury that the information in (applicant's printed commission name, same as # 2 above) this application is true, complete and correct; that I understand the official duties and responsibilities of a notary public in this State, as described in the statutes; that I can speak, read and write in the English language; and that I will perform to the best of my ability all notarial acts in accordance with the law. Signature of Applicant: ________________________________________________________ (This signature must be signed before a notary and match the name on line 2above. This signature must be used when performing ALL notarial acts.) ****************************************************************************************************************************************************************************************** 19. DO NOT NOTARIZE YOUR OWN SIGNATURE. This certificate must be notarized by a commissioned notary other than you. State of North Carolina, County of____________________ Sworn to (or affirmed) and subscribed before me this _____day of ___________________, 20____ , By ______________________________________________. (Name of Applicant) (Official Seal or Stamp) Signature of Notary Public: ________________________________________________ DO NOT NOTARIZE YOUR OWN SIGNATURE. My Commission Expires ________________________________________________, 20_____________ American LegalNet, Inc. www.FormsWorkFlow.com FORM MUST BE COMPLETE, LEGIBLE AND CORRECT OR APPLICATION MAY BE REJECTED OR DENIED PLEASE PRINT IN BLACK INK OR TYPE ASSISTANCE: The Notary Public Section is available for assistance from 8:00am to 5:00pm, Monday through Friday, with the exception of State Holidays. You may contact us by phone at (919) 807-2219, by e-mail at notary@sosnc.com, or by fax at (919)807-2210. Visit our web site at www.sosnc.com FEE: Make check or money order payable to NC Secretary of State in the amount of $50.00. Fees are non-refundable (see N.C. General Statute ยง 10B-13). PLEASE DO NOT SEND CASH. The Secretary of State's Notary Public Section will process your application within 72 hours of receipt under normal circumstances. Notary Public Section Department of the Secretary of State PO Box 29626 Raleigh, NC 27626-0626 Please allow two weeks to receive your oath notification letter. MAIL APPLICATION AND FEE TO: APPLICATION INSTRUCTIONS - ALL INFORMATION REQUESTED IS REQUIRED BY N.C.G.S. 10B-5, 10B-6 &10B-7 1. Enter your full legal name. This name should match the name on your official identification. 2. Enter the name you wish to use for your notary public commission. You may use one initial for the first or middle name or any combination of your full legal name but not two initials. No nicknames are permitted. This name should appear on your seal and must be used in signing all notarized documents. 3. Reappointment applicants must enter the name you used for your previous notary public commission, including the expiration date and county of that commission. You must place an imprint or stamp of your notary seal i
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