Notary Public Application Checklist And Credit Card Transaction Form {I-160.3}

OFFICE OF THE SECRET ARY OF STATE JESSE WHITE Secretary of State Notary Public Application Checklist Dear Notary Applicant: The following checklist should assist you when completing the Illinois Notary Public Application and surety bond: There is a $10 filing fee for appointment and commission for each notary public. The check or money order should be made payable to the Secretary of State. Checks which have been altered, i.e. usage of correction fluid, or are unsigned are unacceptable. This office also accepts VISA, Mastercard and Discover cards (see reverse side). Each Notary Public application must include $5,000 a Illinois Notary Public Bond issued by a company qualified to write surety bonds in Illinois. This office does not accept the Public Official Bond or Errors and Omissions Policy. The surety bonding companys corporate seal must accompany the Signature of Officer or Authorized Representative. The Illinois Notary Public is appointed through the Office of the Secretary of States Index Department. Your official commission date is assigned by this office, not the insurance company or surety bonding company who has underwritten your surety bond. To become an Illinois Notary Public, you must an be Illinois resident or a resident of a qualifying bordering state. Illinois Residents are commissioned in the county in which they reside. Out of State Residents are commissioned in the county in which they are employed. Your name and Signature of Applicant must read exactly the same and be notarized anotherby current Illinois Notary Public; their valid rubber stamp seal must be affixedYou. cannot notarize your own signature. On the bond side, you must sign Signature as of Principal/Applicant. This office accepts only applications and surety bonds with an original signature. The office of the county clerk, in the county in which you reside or are employed, will contact you upon their receipt of your commission. Failure to register with the county will result in cancellation of your commission Please take the time to review the Illinois Notary Public Handbook, in particular pages 4 and 15 which describe a valid Illinois rubber stamp seal, and page 5 which concerns your signature. Notary public applications and appointments are public records and are available to any interested person for examination and copying. If you have any questions or need additional assistance, please contact (217) 782-7017. I-160.3 Springfield, Illinois 62756 <<<<<<<<<********>>>>>>>>>>>>> 2 Secretary of State Index Department Notary Public - Credit Card Transaction Form Notary applicant name and home residence: _________________________________________________________________________________________________ _________________________________________________________________________________________________ Check one ? VISA ? Discover ? MasterCard Credit Card number and expiration date: Card # ________________________________________ Exp. date __________________ Name of authorized representative of credit card and address: _________________________________________________________________________ _________________________________________________________________________ Telephone number: _____________________________________________ Authorized signature of representative of credit card: (Must be included in order to process) ________________________________________________________________________ NOTE: A FEE OF $1.50 WILL BE CHARGED FOR EACH TRANSACTION BY THE CREDIT CARD COMPANY FOR THIS SERVICE. I-160.3