Appl ID (For Filing Officer’s Use Only)
Secretary of State
Notary Public Application
Important – Read instructions before completing this application.
1. Applicant’s Information
a. Social Security Number /Individual Taxpayer Identification No.
b. Date of Birth
c. Driver’s License or ID
d. Full Legal Name: First Name
Middle Name
Last Name
2. Commission Name
Print your name exactly as you want it shown on your commission. Your legal last name must match the last name shown on your
commission.
First Name
Middle Name
Last Name
3. Applicant’s Business and Residence Information
a. Name of Principal Place of Business
b. County where business is located (no abbreviations)
c. Telephone Number
(
)
d. Business Location Address - Do not list a P.O. Box
City (no abbreviations)
State
Zip Code
CA
e. Mailing Address, if different than item 3d
City
State
Zip Code
f. Residence Address - Do not list a P.O. Box
City (no abbreviations)
State
Zip Code
CA
4. Background Information
Attach additional pages, if necessary.
a. List any names(s) previously used.
b. Provide all details if you have 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.
c. Provide all details relating to any professional license or notary public commission denied, revoked, restricted or suspended.
d. List all convictions by any court of a misdemeanor, or a felony, and provide all details for any arrest or citation for an offense for which a trial is pending.
5. Signature and Execution
• I understand that any misstatements or omissions of material facts will result in the denial of my notary public
application or revocation of my notary public commission and possible criminal liability.
• I declare that I am a legal California resident, or I am a federal civil service employee who is a United States citizen
being appointed and commissioned on behalf of a military reservation.
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
Signature:
2016 California Secretary of State
SOS/NP-30 (REV 08/2016)