Application For Michigan Notary Public Commission - Michigan Secretary Of State

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For County Use Only

County Seal

Clear Form

County name

Date of oath

and bond

Oath

Attorney (oath only)

administered

MICHIGAN DEPARTMENT OF STATE

by, and bond

OFFICE OF THE GREAT SEAL

filed with:

(Clerk’s initials)

APPLICATION FOR MICHIGAN NOTARY PUBLIC COMMISSION

(Please print legible or type; ALL fields must be completed or application will be returned)

1. Full Name (first/middle/last):

(must match your State driver’s license or ID card)

Please indicate any previous and/or alias names:

If none, please check box

N/A

3. Driver’s license or personal identification card number:

Issuing state:

City:

State:

Zip:

4. Residence address:

(Must match license or ID file - include PO boxes, lot and Apt numbers)

5. Date of birth:

6. E-mail address:

If none, please check box

N/A

7. Business Street address:

City:

State:

Zip:

If none, please check box

N/A

8. If you are a licensed attorney in Michigan, enter your State Bar number: P-

If you are not a licensed attorney please check box

N/A

9. Michigan resident – County of residence:

Non-Michigan resident - County of employment:

10. Residence Telephone numbers:

Business Telephone number:

If none, please check box

N/A

If none, please check box

N/A

11. Please describe date and circumstance of any felony or misdemeanor convictions during the previous ten years in this or any other

State. Attach additional pages if necessary.

If none, please check box

N/A

12. Do you currently hold or have ever held a notary public commission in this or any other state: Yes

or No

If yes, indicate State: Michigan

or State of _____________ and date ___________ or Unknown

13. Have you ever had a notary public appointment in this or any other state:

revoked,

suspended,

cancelled,

Does not apply to me. If yes, please explain. Attach additional pages if necessary.

I hereby certify that I am 18 years of age or older; a resident of Michigan or maintain a principal place of business in Michigan; am a U.S. citizen or

possess proof of legal presence; am able to read and write in the English language; am not currently incarcerated in a correctional facility or have

served time during the immediate past ten years for a felony or misdemeanor offense in any state. I solemnly affirm, under the penalty of perjury, that

the information provided in this application is true, complete, and correct; that I have carefully read the notary laws of Michigan; 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 the law. I

understand that all information contained on this application is subject to disclosure under the Freedom of Information Act, 1976 PA 442, MCL

15.231, et seq. I am enclosing a check or money order in the amount of $10.00, payable to the State of Michigan, which I understand is a

nonrefundable application processing fee.

COMMISSIONED

NAME:

rint or type your name, as it will appear on all documents you notarize.

SIGNATURE:

Sign your name, as it will appear on all documents you notarize.

Your signature must match your commissioned name printed above.

Form 98 (Rev. 12/14)