Application For Appointment As Notary Public (Page 2 of 6) in pdf

5. Date of Birth________________________________6. Town & State of Birth___________________________________

7. Highest degree awarded and school attended______________________________________________________________

___________________________________________________________________________________________________

8. For what purpose do you expect most frequently to use a notary public appointment?

__________________________________________________________________________________________________

___________________________________________________________________________________________________

9. Have you ever been convicted of a felony or misdemeanor? If yes, please provide date, charge, town, court and terms of

sentence. Do not list parking tickets.

Yes.

No._________________________________________________________________________________________

____________________________________________________________________________________________________

10. Have you ever been a notary public in Connecticut? If yes, indicate under what name, date of appointment and account

number.__________________________________________________________________________________________

____________________________________________________________________________________________________

11. Have you at any time been refused a notarial commission, or had a notarial commission revoked. If yes, please provide

the state, reason and date.

Yes.

No.________________________________________________________________________________________

CERTIFICATE OF CHARACTER

I,_______________________________________________of__________________________________________________,

(town & state)

occupation__________________________________________________________________hereby certify that I have

known_________________________________, the above named applicant, for the past_________________year(s), and

know him/her to be a person of good moral character, and that the applicant is, in my opinion, a suitable person to receive

appointment of Notary Public.

the

Date_____________________________Signature___________________________________________________

Application For Appointment As Notary Public Page 2