Fillable Form Sos/np-30 - California Notary Application

State of California

Secretary of State

Notary Public Application

Read instructions on back before completing this application - type or print in ink

Important –

This application is presented for filing pursuant to California Government Code section 8201.5

1. Social Security Number

2. Date of Birth (month/day/year)

3. Driver's License or ID (Optional)

Appl ID (For Filing Officer’s Use Only)

4. Applicant’s Name

(first)

(middle)

(last)

5. Name of Principal Place of Business (If no business name, enter “Self employed” or "Self")

Telephone Number (Optional)

(

)

6. Business Location Address (Do not list a P.O. Box)

City (Do not abbreviate)

Zip Code

County of Your Business Location (Do not abbreviate)

7. Mailing Address (Where you want notary public information mailed)

City

Zip Code

8. Residence Address (Do not list a P.O. Box)

City

Zip Code

Please check Yes or No for questions 9 to 15:

Yes

9. Have you completed a 6-hour (or 3-hour if applicable) education course approved by the Secretary of State? If yes, enter the vendor number

and the date of completion of the course. Attach your Proof of Completion certificate to this application.

Vendor No. (from certificate)

Date of Completion of Course (from certificate)

Yes

10. Are you a legal resident of California?

Yes

11. Are you a U.S. Citizen? If your answer is “No,” provide your Alien Registration or USCIS Number with the prefix “A” for both numbers.

12. Have you ever used another name? If Yes, list name(s):

Yes

13. Have you ever been held liable by a court in any suit based on fraud or misrepresentation, failure to discharge the duties of a notary public, or

violation of state regulatory law? If Yes, please give details in Item 16.

Yes

14. Have you at any time had a professional license or notary public commission denied, revoked, restricted or suspended? Have you ever had to

resign a license or commission under unfavorable circumstances? If Yes to either question, see instructions provided on back and give details

in Item 16.

Yes

15. Have you ever been convicted by any court of a misdemeanor, OR a felony, OR have you ever been arrested or cited for an offense for

which trial is pending?* If Yes to any of the questions, give details in Item 16. If convicted under another name, list other name(s) in Item 12

above.

*All convictions must be disclosed, regardless of when or where they occurred, and even if you disclosed the conviction on a previous application for a notary

public commission. Convictions that have been dismissed or expunged also must be disclosed, regardless of the basis for expungement, including pursuant to

Penal Code sections 1203.4 or 1203.4a. The only exceptions are traffic infractions, offenses adjudicated in a juvenile court or under a youthful offender law,

and any incident that has been sealed under Welfare and Institutions Code section 781 or Penal Code section 1203.45 (juvenile offenses).

16. Additional Information: (if additional space is required, attach a separate sheet of paper 8 ½” x 11” in size.)

17.For persons previously holding California notary public commissions:

(Print name exactly as shown on previous commission)

(Last Commission No., if known)

(Expiration date)

18. Print your name exactly as you want it shown on your commission. Note: Your last name as listed in Items 4 and 18 must match. You will be required to

present identification to the county clerk when you file your oath and bond that must substantially match the requested official notary public name shown.

(first)

(middle)

(last)

19. I agree and understand that any misstatements or omissions of material facts will result in the denial or revocation of my notary public

appointment and possible criminal liability. I understand that as provided in California Government Code section 8201.5 my name and address

are not confidential and may be disclosed as provided by California law.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing is true and correct.

Executed in the State of ____________________, County of _____________________________, City of _____________________________

(or unincorporated area)

Official

on ______________________. Signature: _______________________________________________________________________________

Date