Application For Appointment As A Notary Public Form

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Application for Appointment as a Notary Public
STATE OF NEVADA
P
C
T
F
:
)
LEASE
OMPLETE
HE
OLLOWING
(USE PEN OR TYPE -- FULL INSTRUCTIONS ON REVERSE/PAGE 2
1.
R
T
S
P
S
:
EAD
HIS
TATEMENT
RIOR TO
IGNING
"I hereby certify that the statements below are true and correct to the best of my knowledge. I enclose a check or money order in the
amount of $35.00 payable to the Secretary of State. I understand this fee is a non-refundable processing fee."
2.
A
'
S
: (Sign exactly as you want your name to appear on the appointment. Include your full last name and your
PPLICANT
S
IGNATURE
original signature. Use this signature on all notarial acts.)
____________________________________________________
Signature
-------------------------------------------------------------------------------
Print your name EXACTLY as your signature appears above
3. CHECK _____Notary Public
_____Notary Public with Limited Powers ________CCR#
_____Non-Resident Notary Public with Limited Powers________CCR#
______Non-Resident Notary Public
4
.
F
N
(no initials):______________________________________________________________________________________
ULL
AME
First Name
Middle Name
Last Name
5.
M
A
:____________________________________________________________________________________________
AILING
DDRESS
Street or P.O. Box
City
State
Zip code
6.
D
T
N
: _____________________
C
: _____________________________
AYTIME
ELEPHONE
UMBER
OUNTY OF EMPLOYMENT
7.
C
R
:____________________
OUNTY OF
ESIDENCE
8.
A
Y
R
N
?
_____yes
______no (If "yes", how long?___________________________)
RE
OU A
ESIDENT OF
EVADA
9.
A
Y
18 Y
A
O
?
_____yes
_____ no
RE
OU
EARS OF
GE OR
LDER
10.
A
Y
U
S
C
?
_____yes
_____ no
RE
OU A
NITED
TATES
ITIZEN
11.
I
N
U. S. C
, A
Y
L
A
P
R
?_______ R
No._____________
F
OT A
ITIZEN
RE
OU
AWFULLY
DMITTED FOR
ERMANENT
ESIDENCE
EGISTRATION
12.
H
Y
E
B
C
F
? _____yes
_____no (NOTE: if you answer "yes" to this question you MUST attach
AVE
OU
VER
EEN
ONVICTED OF A
ELONY
documentation proving that your civil rights have been restored. Without this documentation, your application will be rejected.)
13.
H
Y
E
B
N
N
?_________ I
"Y
," W
W
Y
E
? _____________________
AVE
OU
VER
EEN A
EVADA
OTARY
F
ES
HAT
AS
OUR
XPIRATION DATE
14.
D
Y
C
H
O
U. S. G
? _______
_______
O
OU
URRENTLY
OLD AN
FFICE UNDER THE
OVERNMENT
YES
NO
15.
P
P
N
Y
P
A
(
).________________________
LEASE
ROVIDE THE
UMBER FROM
OUR
REVIOUS
PPOINTMENT
IF APPLICABLE
16.
M
M
_______________________________
OTHERS
AIDEN NAME
.
.
.
.
C
:
SOS
STATE
NV
US
OME VISIT US ON THE INTERNET AT
(revised 04/99)

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