Form 2301 - Application For Appointment As Texas Notary Public (Page 2 of 2) in pdf

Form #2301

Rev. 04/2013

This space reserved for SOS use

APPLICATION FOR APPOINTMENT AS

If renewing, mark this box:

TEXAS NOTARY PUBLIC

Commission Expires:

Identifying Information

Please Type or Print Legibly

Name to be used as notary public:

Social Security No.:

(This is the name you will be required to sign when notarizing.)

Last

First

Middle (not required)

Suffix

Required by TX Gov't Code §406

Mailing Address:

Residence County:

(Please notify the secretary of state of an address change within 10 days)

Street

City

State

Zip

Email address for return of commission (print legibly):

(Your commission will come from notarypubliccommission@sos.state.tx.us and you will NOT receive materials by mail.)

Alternate email address for return of commission (optional):

Date of Birth:

Driver's License or Identification No.:

Issuing state:

Statements Relating To Qualification

the above-named applicant

, have never been convicted of a felony or crime involving moral

turpitude, am at least 18 years of age and a legal resident of Texas. {All applications are subject to a background check.}

Please select one of the following:

I have been found guilty of a crime other than a Class C misdemeanor. (Applicants selecting this option must attach the

following for each crime: (1) copies of court order and sentence, and papers pertaining to release from probation; and (2)

a statement of (i) the nature, circumstances, date, and location, and (ii) whether the case is on appeal.)

{A conviction for

a crime involving moral turpitude OR a FELONY disqualifies you from appointment as a notary public under Texas law.}

B. I have never been found guilty of a crime OR I have only been found guilty of a Class C misdemeanor, e.g. minor traffic

violations such as speeding.

Notary Public Surety Bond

(This space reserved for agency/bonding company)

KNOW ALL PERSONS BY THESE PRESENTS:

the above-named applicant

That we,

, as principal, and

WESTERN SURETY COMPANY

as surety, a corporation duly licensed to do business in the state of Texas, are held and firmly bound unto the governor of the

state of Texas and to his/her successors in office, in the sum of TEN THOUSAND DOLLARS for the payment of which, well

and truly be made we bind ourselves, our heirs, executors and administrators jointly and severally. As a condition of this

bond, the above-named principal shall faithfully perform all duties of the office of notary public.

BOND NUMBER:

Agency Name:

Address:

Street

City

State

Zip

Date:

Signature of authorized person for surety

Statement of Officer

the above-named applicant

, do solemnly swear (or affirm) that I have not directly or indirectly paid, offered,

promised to pay, contributed, or promised to contribute any money or thing of value, or promised any public office or

employment for the giving or withholding of a vote at the election at which I was elected or as a reward to secure my

appointment or confirmation, whichever the case may be, so help me God.

Execution

I declare under penalty of perjury that the facts in the foregoing Statement of Officer are true. I further certify that the

information provided in and with this Application is true and correct and that I am not disqualified by law or any other reason

from holding the office of notary public. I agree to be bound by the terms and conditions of the incorporated surety bond.

Date:

Signature of Applicant

(sign in name given above on line #1 to be used as notary public)

Form 2301

Questions may be directed to the Notary Public Unit at 512-463-5705.

Form 2301 - Application For Appointment As Texas Notary Public Page 2

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