Notary Public Application / Criminal Record Release Authorization Form printable pdf download

State of New Hampshire

NOTARY PUBLIC Application

Department of State

PRINT CLEARLY

State House – Room 204

Name _______________________________________________________________

Concord, N.H. 03301

First name

Middle

Last Name

603-271-3242

Street Address: _______________________________________________________

City/Town State _____________________________ Zip Code _________________

Date of Birth: ___________________ Phone Number _______________________

Date: _____________________

Mailing address if different from above _____________________________________

I declare that I am of legal age and a resident of the State of New Hampshire. I respectfully solicit of the Honorable

Governor and Executive Council an appointment as Notary Public for the State of New Hampshire.

I have never been convicted of a crime that has not been annulled by a court, other than minor traffic violations, with

the exception of: (state details) ____________________________________________________________________

_______________________________________________________________________________________________

Subscribed and sworn to before me this ______ day of ____________________, 20 __

seal

________________________________________

_________________________________

Signature of Applicant

Notary Public/Justice of the Peace

Print this form. After completing and signing, mail to Secretary of State’s Office WITH THE CRIMINAL RELEASE

AUTHORIZATION FORM and the $75. fee.

This application must have the signatures of three individual endorsers, two of whom shall be New Hampshire Notaries

Public in good standing and one registered voter in the state.

1) NOTARY PUBLIC for New Hampshire

2) NOTARY PUBLIC for New Hampshire

______________________________________

_________________________________________

Signature of Endorser

______________________________________

_________________________________________

Print Name of Endorser

______________________________________

_________________________________________

Street Address

______________________________________

_________________________________________

City/Town/State/zip code

1) REGISTERED VOTER of New Hampshire

______________________________________

Fee of $75.00 must accompany this application.

Signature of Endorser

Make check payable to: Treasurer, State of New Hampshire

______________________________________

Applications require 8-10 weeks to process

Print Name of Endorser

______________________________________

Street Address

___________________________________

FOR OFFICE USE ONLY

Check No. _________________

City/Town/State/zip code

Amount: __________________

Notary Public Application / Criminal Record Release Authorization Form

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