Notary Public Application Instructions (Page 2 of 2) in pdf

State of Arizona – Office of the Secretary of State

RITE IN

HIS

PACE

Notary Public Application

This application is a legal document

SEND BY MAIL TO:

Secretary of State Ken Bennett, Atten: Notary Division

1700 W. Washington Street, FL. 7, Phoenix, AZ 85007-2808

OR return the application in person:

KEN BENNETT

PHOENIX - State Capitol Executive Tower,

TUCSON - Arizona State Complex,

Secretary of State

1700 W. Washington Street, 1st Fl., Room 103

400 W. Congress, 1st Fl., Suite 139-1

Office Hours: Monday through Friday, 8 a.m. to 5 p.m., except state holidays.

PLEASE NOTE:

FFICE

NLY

The notary commission application process takes about four weeks.

SOSNPA

. 12/20/2013

Applicants must purchase a Notary Bond BEFORE submitting this application.

Notary Public Application instructions are available online at

When to use this form: Complete this form to apply or renew a Notary

Be Accurate: Complete all applicable fields on this form. The

Public Commission. Before proceeding, read the Notary Public

applicant’s name on this form must EXACTLY match the name on the

Reference Manual. Write legibly; or fill out this application online at

notary bond.

and print it.

Questions? Call (602) 542-6187; in-state/toll-free (800) 458-5842.

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1. APPOINTMENT TYPE

Check One

New Appointment

Renewal/Reappointment

If your surname has changed and you are reapplying identify in the space provided the exact name you used on your last application. Refer to the information on your

commission certificate. If you only want to change the surname on your commission, use the “Notary Public Address/Name Change Form.”

Previous First Name

Previous Last Name

Previous Middle Name (IF USED)

2. APPLICANT INFORMATION

Last Name

First Name

Middle (IF USED)

Mailing Address -This is where your certificate will be mailed

City

State

Zip Code

Home (Physical) Address

City

State

Zip Code

Applicant Social Security #

**AZ DL/ID #

Issue Date

Home Telephone #

Gender

Date of Birth

(

)

M / F

Exp Date

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Apache

Cochise

Coconino

County of Residence

Gila

Graham

Greenlee

La Paz

Maricopa

Check One



Mohave

Navajo

Pima

Pinal

Santa Cruz

Yavapai

Yuma

3. BUSINESS/EMPLOYER INFORMATION (The Business Name and Address is a public and will be displayed on our website.)

Business/Employer Name (Business/Employer is a public record)

Address (REQUIRED FIELD, Business/Employer address is public record)

City

State

Zip Code

Telephone Number (Include area code)

Fax Number (Include area code)

E-mail Address

(

)

(

)

YES NO

4. DISCLOSURE

a. Have you ever been convicted of a felony OR a lesser offense involving moral turpitude of a nature that is incompatible with the duties of a notary



public?



If “YES” have you had you civil rights restored? If your rights have been restored you MUST provide and attach: court documentation that demonstrates





the restoration of your civil rights; and a court or law enforcement issued document that refers to the nature of the original charges.

n/a



b. Have you ever had a professional license revoked, suspended, restricted, or denied for misconduct, dishonesty, or any cause that substantially relates

 

to the duties or responsibilities of a notary public? If yes, attach an explanation statement.

c. Have you ever had a notary commission revoked, suspended, restricted, or denied in this state or any other jurisdiction? If yes, attach an explanation

 

statement.

d. Are you 18 years of age or older?

 

Are you a citizen or a legal permanent resident of the United States? **

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f. Do you claim Arizona as your primary residence for state and federal tax purposes?

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g. Can you read and write English?

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h. Have you been commissioned as a notary public in any other state or jurisdiction?

If “YES” please specify the jurisdiction(s)

 

i. Will you be performing notarizations in languages other than English?

If “YES” specify the language(s).



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Note: You must be able to understand a language in order to perform notarizations in

n/a



that language. Information provided is a public record.

5. APPLICANT ATTESTATION: OFFICE OF THE ARIZONA SECRETARY OF STATE

Print your full name as provided in Section 2

solemnly affirm, under penalty of perjury, that the answers to all questions on this

application and all copies of documents included with this application true, complete, unaltered and correct; that I have carefully read and understand the

notary law (Title 41, Chapter 2, Article 2) of this State; and that, if appointed and commissioned as a notary public, I will perform faithfully, to the best of my

ability, all notarial acts in accordance with Arizona notary law.

Signature of Applicant (Sign as printed)

Date

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