Notice Of Loss Or Theft Notary Journal Seal Comission Certificate | Pdf Fpdf Doc Docx | Arizona

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Notice Of Loss Or Theft Notary Journal Seal Comission Certificate | Pdf Fpdf Doc Docx | Arizona

Notice Of Loss Or Theft Notary Journal Seal Comission Certificate

This is a Arizona form that can be used for Notary within Secretary Of State.

Alternate TextLast updated: 3/29/2017

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State of Arizona ­ Office of the Secretary of State Notary Public Notice of Loss or Theft Notary Journal/Seal/Commission Certificate SEND BY MAIL TO: DO NOT WRITE IN THIS SPACE Secretary of State Michele Reagan, Atten: Notary Division 1700 W. Washington Street, FL. 7, Phoenix, AZ 85007-2808 OR return the application in person: PHOENIX - State Capitol Executive Tower, TUCSON - Arizona State Complex, 1700 W. Washington Street, 1st Fl., Room 103 400 W. Congress, 1st Fl., Suite 141 Office Hours: Monday through Friday, 8 a.m. to 5 p.m., except state holidays. IN-PERSON ONLY - We accept major credit cards and bank debit cards. PLEASE NOTE: A notary commissioned in the State of Arizona has 10 days to notify our office under statute of a stolen seal, certificate, and/or journal. INSTRUCTIONS When to use this form: Use this form to report to the Secretary of State the loss or theft of a Notary Journal and/or Seal and/or Commission Certificate. Contact Authorities: Before using this form, contact your local law enforcement agency and file a loss/theft report (A.R.S. § 41-323(B)). Notification Requirements: A notary public shall notify the office within 10 DAYS as specified under A.R.S. § 41-323(B). Failure to comply with this law may result in a $25 civil penalty fee. Under A.R.S. § 41-323(C), failure of notification may be grounds for a commission to be revoked because "the notary has failed to fully and faithfully discharge the duties of a notary." Be Accurate: Print clearly for accuracy or computer generate this form online. FOR OFFICE USE ONLY SOSBSNOTICE REV. 3/12/2015 Replacement Certificates: To request a new commission certificate, send this form and a $18 check or money order made payable to Secretary of State. The certificate is mailed to the mailing address on file. Submission:This report must be sent by means providing a receipt under A.R.S. § 41-323(B). Send it by certified mail, fax it to (602) 5424366 or deliver in person to the Secretary of State's Phoenix or Tucson office. Processing: 2-3 weeks; expedited service, include an additional $25 (24-48 hours). Website: All forms are available on the Secretary of State's Website, www.azsos.gov. Questions? Call (602) 542-6187; in-state/toll-free (800) 458-5842. 1. Notary Information NOTARY COMMISSION NUMBER OR SOCIAL SECURITY NUMBER LAST NAME (As shown on notary certificate) PHONE NUMBER BUSINESS NUMBER FIRST NAME (As shown on notary certificate) MIDDLE (If used) E-MAIL ADDRESS ( ) ( ) MISSING STOLEN MISSING STOLEN DATE MISSING or STOLEN DATE MISSING or STOLEN OTHER 2. Notice of Loss or Theft ~ Check Appropriate Boxes a.JOURNAL b. SEAL OLD SEAL DESCRIPTION COLOR INK SHAPE It is recommended that you purchase a new seal that is a different shape from the missing seal to distinguish it from the old seal. NEW SEAL DESCRIPTION COLOR INK SHAPE OTHER DATE MISSING or STOLEN c. COMMISSION CERTIFICATE MISSING STOLEN Please send me a replacement commission certificate. Enclosed is a check or money order for $18 made payable to the Secretary of State. I would like expedited service. Enclosed are $18 and $25 checks made payable to the Secretary of State. 3. Loss/Theft Enforcement Agency Report Information REPORT OR CASE NUMBER DEPARTMENT, OFFICE or AGENCY NAME NAME of OFFICER OR AGENT PREPARING REPORT CONTACT INFORMATION (Phone, e-mail, address etc.) 4. NOTARY SIGNATURE ~ This notice shall be signed by the notary public under A.R.S. § 41-323(B) SIGNATURE (Required) | DATE Month Day Year Arizona D epartment of State Office of t he S ecret ary of State American LegalNet, Inc. www.FormsWorkFlow.com Michele R eagan, Secretary of St ate

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