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

STATEMENT OF OFFICER

(Pursuant to Art. XVI, Section 1(b), Texas Constitution)

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

(Applicant’s Name)

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.

UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING STATEMENT AND THAT THE FACTS STATED THEREIN ARE TRUE.

(Signature of Applicant)

Date _____________________________

Official Notary Public Bond for the State of Texas

Take the Official Bond form below to any insurance agency or bonding company for completion,

unless it is preprinted with the name and address of an insurance agency/

surety company. If it is so preprinted, return it to the agency specified on the bond for completion. DO NOT ALTER THE BOND IN ANY MANNER.

Only a bond written

on a company licensed in Texas to issue fidelity and surety bonds will be accepted. A premium will be collected by the insurance/surety company from which you purchase the

surety bond. The Texas Department of Insurance does not have a standard premium rate for this bond limit; thus, you must check with the insurance/surety company for the

approved premium rate.

STATE OF TEXAS

COUNTY OF HARRIS

KNOW ALL PERSONS BY THESE PRESENTS: THAT WE,

(Applicant’s Name)

PRINCIPAL AND WESTERN SURETY CO., A CORPORATION DULY LICENSED TO DO BUSINESS IN THE STATE OF TEXAS, AS SURETY, 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 ($10,000) FOR THE PAYMENT OF WHICH, WELL AND TRULY TO BE MADE WE BIND OURSELVES, OUR HEIRS,

EXECUTORS AND ADMINISTRATORS JOINTLY AND SEVERALLY BY THESE PRESENTS.

THE CONDITION OF THIS BOND IS SUCH THAT THE ABOVE NAMED PRINCIPAL HAS BEEN APPOINTED A NOTARY PUBLIC FOR THE STATE

OF TEXAS SHALL FAITHFULLY PERFORM THE DUTIES OF SAID OFFICE OF NOTARY PUBLIC, THEN THIS SHALL BECOME NULL AND VOID,

OTHERWISE IT SHALL REMAIN IN FULL FORCE AND EFFECT.

WITNESS OUR HANDS ON THIS

DAY OF

Insurance or Bonding Company:

WESTERN SURETY CO.

BY:

(Signature of Surety Officer or Attorney in Fact)

Agency Name: American Association of Notaries

, , , , ,

Signature of Principal (Applicant)

Agency Address: 8811 Westheimer, Suite 207

Houston, TX 77063

INSTRUCTIONS

Complete both sides of this form using black ink or a typewriter. THIS FORM MUST BE ONE PAGE, FRONT AND BACK (81/2 X 11).

RENEWALS: Same procedure and fee as required for obtained original commission. A Notary Public may be reappointed upon submission of a new application

not earlier than ninety (90) days prior to the expiration of the Notary Public‘s term. A Notary Public who is not reappointed on or before the

expiration date of the term the Notary Public is serving will be appointed for a new term expiring four years from the date of qualification.

COSTS TO BE A TEXAS NOTARY PUBLIC: Secretary of State fees $21.00; the applicable premium payable to the insurance/surety company from which

you purchase a $10,000 surety bond; and the costs of purchasing a personalized notary seal and record book (see accompanying coupon).

For bonding and supplies, return this completed application, order form and payment to: American Association of Notaries, P.O. Box 630601, Houston, TX 77263

Form 2301 (Rev. 11-21-05)

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

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