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Notary Commission Application - Minnesota
| Notary Commission Application Form. This is a Minnesota form and can be used in Notary Secretary Of State . |
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MINNESOTA SECRETARY OF STATE Retirement Systems of MN Building 60 Empire Drive, Suite 100 St. Paul, MN 55103 651-296-2803 (toll free at 1-877-551-6767) Press Option 3 Email: notary.sos@state.mn.us (For Department Use Only) NOTARY COMMISSION APPLICATION COMMISSION NUMBER DATE PROCESSED The data which you furnish on this form will be used by the Office of the Secretary of State and the Department of Commerce to assess your qualifications for a commission. After issuance of the commission your name and designated address is public pursuant to Minnesota Statutes, Chapter 13. A. APPLICATION (Check applicable box) NEW APPOINTMENT Fee: $120 REAPPOINTMENT Fee: $120 (commission has expired) RENEWAL Fee: $120 (can also be renewed online at notary.sos.state.mn.us) ADDRESS CHANGE No Fee (can also update online at notary.sos.state.mn.us) NA ME CHANGE No Fee (attach legal documentation) B. COMMISSION NUMBER (Required for reappointment, renewal, address change and name change) CURRENT COMMISSION NUMBER C. APPLICANT INFORMATION (List your name the way it appears on your driver's license, tax returns and legal documents.) MIDDLE NAME OR INITIAL LAST NAME FIRST NAME RESIDENTIAL STREET ADDRESS (PO Box must include Rural Route or Street Address) CITY STATE ZIP CODE DATE OF BIRTH mo/day/yr: (Applicant must be 18 years old) TELEPHONE NUMBER with area code EMAIL ADDRESS ( ) COUNTY OF RESIDENCE (Non-residents must list a Minnesota County he or she will be filing in upon receiving their notary commission from the Office of the Secretary of State.) D. BUSINESS NAME AND ADDRESS (Optional - applies when notarization is a function of your job) BUSINESS NAME BUSINESS ADDRESS (Business location where the notary conducts business, PO Box must include Rural Route or Street Address) CITY STATE ZIP CODE TELEPHONE NUMBER with area code ( ) Check address you want shown on public lists: (Must check one and can check both. If none are checked, default is residential) Residential Address E. Business Address FORMER RESIDENTIAL ADDRESS (required if filing an address change) FORMER RESIDENTIAL STREET ADDRESS (PO Box must include Rural Route or Street Address) F. FORMER NAME (required if filing a name change) FORMER NAME (Must attach legal document showing the name change; i.e. copy of marriage certificate, divorce decree, driver's license, court order, etc.) American LegalNet, Inc. www.FormsWorkFlow.com ALL applicants MUST answer questions 1-4. If the answer to any question is YES, you must attach an explanation including the specific dates, charges, resolution, attach copies of legal documentation and complete the background check form. All items including these answered questions, Notary Application, Background Check Form and supporting documentation when applicable, must be mailed together to the Office of the Secretary of State. 1. Have you ever been the subject of any inquiry or investigation with respect to a notary commission or by any division of the Minnesota Commerce Department? (If yes, attach written explanation and copies of Department letters or order.) Have you or has any occupational license held by you been censured, suspended, revoked, canceled, terminated or been the subject to any type of administrative action in any state including Minnesota? (If yes, attach written explanation and copies of Department letters or order.) Have you ever been charged with, or convicted of, or been indicted for, or entered a plea to, any criminal offense (felony, gross misdemeanor or misdemeanor), in any State or Federal Court? (If yes, attach written explanation and copies of complaint, sentencing and disposition documents, and if currently on probation, attach letter from probation officer stating compliance with terms of probation.) Note: This does NOT include traffic violations such as DUI, DWI, speeding, etc. Have you been a defendant in any lawsuit involving claims of fraud, misrepresentation, conversion, mismanagement of funds, breach of fiduciary duty or breach of contract? (If yes, attach written explanation and copies of court documents.) YES NO 2. YES NO 3. YES NO 4. YES NO APPOINTMENT OF THE SECRETARY OF STATE AS AGENT FOR SERVICE OF PROCESS. KNOW ALL PEOPLE BY THESE PRESENT: That in compliance of the Laws of the State of Minnesota, I, the undersigned applicant, if a nonresident, do hereby appoint the Secretary of State of the State of Minnesota, his/her successor or successors, as my true and lawful agent upon whom may be served all legal process in any action or proceeding in which I may be a party arising out of or relating to the transactions of the commission, and do hereby expressly consent and agree that service upon such agent shall be as valid and binding as if due and personal process has been made upon me and that such appointment shall be irrevocable. I certify that the statements in this application and attachments are true and complete and that this document has not been altered or changed in any manner from the form adopted by the Office of the Secretary of State. OATH: I swear to uphold the duties of a Notary Public in the State of Minnesota. ________________________________________________ ___________________________________ Signature of Notary Applicant Date American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS 1. 2. To obtain a Notary commission, submit this completed application with the application fee to the Office of the Secretary of State. The notary commission fee is $120.00. The fee is non-refundable and must be paid by check or money order made payable to the OFFICE OF THE SECRETARY OF STATE Do not send cash through the mail. Applicant must be at least 18 years of age. Applicant must be either a Minnesota resident, or a resident of a county in IA, ND, SD, or WI and list the Minnesota County he or she will be filing in upon receiving their commission. Non-resident notary applicants must designate the Secretary of State as their agent for service of process. Upon receipt of your commission, you must register it with the county. Your resident county name and telephone number will be listed in the instructions portion of your commission certificate. Please contact the county for directions to the appropriate location to register your commission. Note: there is a $20.00 fee charged at the county level. Upon receipt of your commission, you must purchase a notary stamp. When you notarize a document, your notary stamp must match the name on your commission certificate however you ma
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