Form 62-01 - Notary Public Appointment Page 2
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1
2Contact Information
Notary Public
Kansas Secretary of State
Memorial Hall, 1st Floor
Appointment Form
120 S.W. 10th Avenue
Topeka, KS 66612-1594
(785) 296-2239
Instructions
notary@sos.ks.gov
A. Personal Information
(1) Enter the name of the applicant. The name listed here must match exactly to the name printed on the notary stamp in
question (4). Initials in place of a first name (J. Michael Doe or J. M. Doe) and prefixes (Doctor, Father, Mrs.) are not ac-
ceptable. We recommend that your name be listed as it is listed on your state issued driver’s license or identification card.
(2) Enter the street address of the residence of the applicant. This must be a physical street address
no post office boxes
–
will be accepted unless a residential street address is also listed. The notary certificate will be mailed to this address upon
successful application.
(3) Enter the work street address of the applicant.
(4) Affix an impression of the notary stamp that the applicant will be using. If the applicant chooses to use more than one
stamp, an impression of each must appear in the space provided. The applicant may either use a “seal press” (impression seal)
with the impression to be blackened, or a rubber stamp to be used with permanent ink. The seal must include the applicant’s
name and the words “Notary Public” and “State of Kansas.” “My appointment expires __________ ” also may be included.
Do not include the county within the seal. Although you must obtain your seal or stamp before completing the application
process, you will not be authorized to notarize documents until you receive your certificate of appointment from the secretary
of state. The name on the stamp must match the name entered on the application (1) and the applicant signature (8).
(5) Enter the applicant’s daytime telephone number. (The best number to reach the applicant during the day.)
(6) Enter a secondary telephone number for the applicant. (This could be a cell phone, home phone or work number.)
(7) Enter the expiration date of the applicant’s last appointment if he or she is currently a Kansas notary public or has ever
been a Kansas notary public.
B. Oath
(8) The applicant should sign the application after reciting the oath in the presence of a legally authorized notary public.
(9) The notary completing the oath (notarizing the applicant’s signature) should complete the state and county in which the
notarization takes place.
(10) The notary public who is notarizing the document should complete the date the oath was administered.
(11) The notary public who is notarizing the document should enter the date his or her notary commission expires.
(12) The notary public who is notarizing the document should sign the document and affix his or her notary seal in the space
provided to the right of his or her signature.
C. Notary Surety Bond
The law requires a notary public to be bonded in the sum of $7,500 for a four (4) year period automatically coinciding with
the appointment. The bond must be a commercial surety bond from an insurance company licensed to do business in Kansas.
(13) Enter the name and physical address of the commercial surety company.
(14) The signature should be completed by the Attorney in Fact from the insurance company and also the date he/she signed
the bond. An insurance company must affix a corporate seal or attach its Power of Attorney.
D. Notary Application Filing Fee
Attach your check of $25 for filing the notary appointment form, made payable to the secretary of state.
Notice: There is a $25 service fee for all returned checks.
Notice: You are not a notary until you have received your notary certificate at your residence from the Kansas Secretary of State.
Rev. 4/13/16 tc
K.S.A. 53-103
2/2
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