Four Year Commission Notary Public Application {100}

State of Wisconsin Four-Year Notary Public Commission Application OFFICE USE ONLY COMMISSION DATE: Fee: $20.00 1. Is this your first Wisconsin commission? Yes No If 223No,224 indicate the most recent expiration date: 2. If the name on your last commission has changed and you have not notified us, list former name(s) here: 3. Current Full Name: First Middle Last Suffix 4. Mailing Address In Care of: (Business Name, if appl icable) Street Address or PO Box City State Zip Code 5. Email Address (For contact and/or emailing the commission certificate) 6. Date of Birth (MM/DD/YYYY) 7. Phone Number (Best number to contact) 8. Place a clear impression of seal/stamp sample here. If impression is not clear, apply sample and signature to plain white paper and include with this application. 11. Have you ever been convicted of a felony in Wisconsin and/or the United States? Yes No If 223Yes,224 submit documentation of the conviction(s) and indicate current status of the conviction(s). 12. To the Department of Financial Institutions: I hereby apply for a four-year appointment as a Wisconsin Notary Public. I certify that I am a United States resident, educated with regard to the duties and responsibilities of a Notary Public, and that I have at least the equivalent of an eighth grade education, and that all of the information I have provided is true. Applicant Signature Email or mail completed application to: DFINotary@wisconsin.gov Mailing Address: Contact us: Notary Records Section Call: 608-266-8915 WI Dept of Financial Institutions Fax: 608-264-7965 PO Box 7847 Madison WI 53707-7847 Submit: Completed application Oath of Office Notary Bond Notary Exam Certificate $20.00 (if not already submitted electronically) 9. Sign your name exactly as it appears on your seal/stamp 10. Print your name exactly as it appears on your seal/stamp First Middle Last Suffix DFI/NOT/100 (R08/17) Page 1 of 4www.FormsWorkFlow.com State of Wisconsin Department of Financial Institutions Notary Records Four - Year Notary Public Commission Application Instructions This document may be made available in alternative formats upon request to qualifying individuals with disabilities. You may NOT perform notarial acts until you are notified by the Department of Financial Institutions that the commission has been issued or reissued in the case of a reappointment. General Requirements: In order to become a Notary Public under Wisconsin Statute 247137.01, you must be a resident of the United States, 18 years of age or older, have at least the equivalent of an eighth grade education, pass the online Notary Public exam (https://www.wdfi.org/apps/NotaryTutorialExam/TableOfContents.aspx ) with 90% or better, (this can be taken an unlimited number of times until you pass) and have demonstrated adherence to laws according to Wisconsin Statutes with regard to arrests/citations/convictions. (Note that under current law, persons convicted in state or federal court of a felony, or persons convicted of a misdemeanor involving a violation of the public trust, may not be commissioned as notaries public for the State of Wisconsin unless they have been pardoned of the conviction.) You must purchase: an engraved official seal or official rubber stamp that only contains 223State of Wisconsin,224 223Notary Public224 and your printed name that must include your full current last name. No title such as 223Dr.224 or 223CPA224 should appear before or after your name. a $500.00 bond. Instructions for the Four-Year Notary Application. 1. Indicate the expiration date of your most recent Wisconsin notary commission unless this is your first commission. 2. If you had a previous notary commission in Wisconsin and your name has changed, enter your former name(s). 3. Enter your current full legal name (first, middle, last and suffix (Jr, Sr, if applicable). 4. Enter your complete mailing address. Use 223In Care Of224 only if the mailing address is a business address. 5. Please enter your email address to receive communication regarding your notary application and commission certificate. You may wish to add 223DFINotary@wisconsin.gov224 to your contacts to prevent the email from being sent to a spam folder. 6. Enter your date of birth. 7. Enter your phone number with the area code. If you have an extension, enter that after your phone number. 8. Affix a clear impression of your notary seal/stamp in the space provided. (If the impression/stamp leaves an unclear mark, affix additional samples on a separate white sheet of paper and include the paper with your application.). 9. Sign with your official notary signature using the exact spelling as shown on your notary seal/stamp. 10. Enter your name exactly as signed (and as the name appears on the seal/stamp). 11. Answer 223Yes224 or 223No.224 Attach an explanation if you answered 223Yes224. 12. Read the statement and apply your original signature. You must complete and submit the following: Four-year Notary Public Commission Application Notary Bond Form Oath of Office Form Certificate from passing the Notary Exam with 90% or better (www.wdfi.org/apps/NotaryTutorialExam/TableOfContents.aspx ), taken within 1 year of the date of submission of the application. $20 filing fee made payable to the Wisconsin Department of Financial Institutions (if not already submitted electronically) Email or mail completed application to: Contact us: DFINotary@wisconsin.gov Call: 608-266-8915 Notary Records Section Fax: 608-264-7965 WI Dept of Financial Institutions P. O. Box 7847 Madison WI 53707-7847 NOTICE: You are hereby informed that the information you provide on the application may be considered a public record available for public inspection. Wisconsin Statutes require that you provide written notice of any change of address to the Wisconsin Department of Financial Institutions within 10 days of the change. Grounds for revocation of your commission may include: providing false information on this application, submitting an application fee which is unredeemable due to insufficient funds or conviction for certain crimes while holding a commission. DFI/NOT/100 (R08/17) Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com State of Wisconsin Department of Financial Institutions Notary Records Oath of Office Four-Year Notary Public Commission Notary Applican t Section (person applying for a four - year notary public commission): ***IN THE PRESENCE OF A NOTARIAL OFFICER*** Complete lines 1 and 2. Do not notarize your own signature! I do solemnly swear that I will support the Constitution of the United States and the Constitution of the State of Wisconsin, and will faithfully discharge the duties of the office of Notary Public, in and for the State of Wisconsin, to the best of my ability; that I am a resident of the United States, and am 18 years of age or older. 1. Notary Applicant Signature: 2. Notary Applicant Printed Name: Notarial Officer Section (person who administers the oath to the applicant, and watches the applicant sign): Complete lines 3-9. Officer who signs line 6 may not be the applicant who signs line 1. 3. State of 4. County of 5. Subscribed and sworn to before me on this day (MM/DD/YYYY): Note: The name and signature in numbers 6, 7 and 8 must be spelled exactly the same. 6. Signature of Notarial Officer: 7. Print name of Notarial Officer: 8. Seal/Stamp of Notarial Officer 9. Check only ONE box : Notarial Officer is a Notary Public whose commission expires on . OR Notarial Officer is a Notary Public whose commission is Permanent. OR Notarial Officer is not acting as a Notary Public but as authorized by Section 706.07 or 887.01, Wis. Stats., with this title: DFI/NOT/100 (R08/17) Page 3 of 4 www.FormsWorkFlow.com State of Wisconsin Department of Financial Institutions Notary Records Bond Instructions All persons applying or reapplying for a four-year notary public commission must purchase a $500 bond from an insurance company. Contact the insurance company of your choice to purchase a bond. This bond form, or a bond form supplied by an insurance company, must be completed and submitted to the Wisconsin Department of Fina