E-Notarization Authorization

STATE OF MINNESOTA SECRETARY OF STATE E-NOTARIZATION AUTHORIZATION Please read the instructions on the back of this form before completing this application. NO Fee is Due for E-Notarization Effective July 1, 2006, the Minnesota Legislature enacted electronic notary legislation pursuant to Minnesota Statutes 358 and 359, allowing electronic notarization to be applied to a document so that the document can be fully processed electronically. Physical presence of a person whose signature is being notarized is still required by law. Before performing electronic notarial acts, a notary public must register or in the case of a recommission, reregister the capability to notarize electronically with the secretary of state. Note: Applicants must be currently registered as an active Minnesota Notary and have the capability to notarize electronically before requesting authorization to perform electronic notarizations. APPLICANT INFORMATION (please type or print legibly) FIRST NAME MIDDLE NAME OR INITIAL LAST NAME RESIDENT STREET ADDRESS (PO Box must include Rural Route or Street Address) CITY STATE ZIPCODE DATE OF BIRTHmo/day/yr: TELEPHONE NUMBER with area code EMAIL ADDRESS COUNTY OF RESIDENCE (Required) IS YOUR COMMISSION RECORDED IN YOUR COUNTY OF RESIDENCE? By signing the certification statement below, you are certifying that you have filed your notary public commission in the county where you live, are in possession of that proof (receipt or copy) and that you can produce that proof upon request. If you have not filed with your resident county, you will need to comply with Minnesota Statutes 357.021 Subd.2 (12) before applying for e-notarization authorization. ORIGINAL COMMISSION NUMBER (Required) I certify that the statements in this application 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. I further certify that I have filed my notary public commission in the county where I live pursuant to Minnesota Statutes 357.021 before applying for e-notarization authorization and that I can provide proof of that registration upon request. OATH: I swear Date Signature of Notary Applicant American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS 1.To obtain the authorization to perform electronic notarizations please complete the applicationand certify that you have proof of the filing of your notary commission with the county. 2.Mail to: Minnesota Secretary of State - NotaryRetirement Systems of Minnesota Building 60 Empire Drive, Suite 100 St Paul MN 55103 3.Upon the acceptance of this application you will receive an E-Notarization Authorization Certificatefrom the Office of the Secretary of State authorizing you to perform electronic notarizations. 4.If you should change your county of residence, renew your commission or your commissionexpires, you must re-register for E-notarization with the secretary of state. 5.Minnesota Statute, Chapters 357, 358 and 359 (which govern notaries and notarial acts) may bedownloaded from the Minnesota Legislature website www.leg.state.mn.us or purchased through theMinnesota Bookstore at 651-297-3000. If you have any questions regarding this application, please call 651-296-2803 or dial toll free at 1-877-551-6767. All of the information on this form is public. Minnesota law requires certain information to be provided for this type of filing. If that information is not included, your document may be returned unfiled. This document can be made available in alternative formats, such as large print, Braille or audio tape, by calling (651)296-2803/voice. For a TTY/TTD (deaf and hard of hearing) communication, contact the Minnesota Relay Service at 1-800-627-3529 and ask them to place a call to (651)296-2803. The Secretary of State's Office does not discriminate on the basis of race, creed, color, sex, sexualorientation, national origin, age, marital status, disability, religion, reliance on public assistance or political opinions oraffiliations in employment or the provision of service. American LegalNet, Inc. www.FormsWorkFlow.com