Change In Status Form - Resignation
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For Office Use Only
TATE OF
OUTH
AROLINA
O
S
S
FFICE OF THE
ECRETARY OF
TATE
_________________
T
H
M
H
HE
ONORABLE
ARK
AMMOND
Date Received
Change in Status Form—Resignation
_________________
Date Updated
No Filing Fee
Pursuant to S.C. Code of Laws §26-1-140(B), when a notary ceases to reside in South Carolina or becomes
permanently unable to perform his or her duties, the notary shall resign his or her commission and notify the
Secretary of State of the resignation using the Change in Status Form. Please type or print in black or blue
ink.
I, _______________________________, resign my commission as a notary public effective
(name as commissioned)
as of: _____________________________________________________________________.
(effective date of resignation)
Please provide your date of birth: _____________________________________________________.
Sworn to and subscribed before me
__________________________________________
Date
This _____ day of __________, ______.
__________________________________________
Printed Name of Applicant
_________________________________
Notary Public of South Carolina
__________________________________________
Signature of Applicant
My Commission Expires: ____________
*Please sign here using your name as
commissioned.
Filing Instructions
1. Return by mail or hand delivery to:
Secretary of State
Attn: Notary Division
1205 Pendleton Street, Suite 525
Columbia, SC 29201
2. This form must be signed and notarized. You cannot notarize your own signature, but must have it notarized by
another notary.
3. The Notary Public Division is open from 8:30 a.m. to 5:00 p.m., Monday through Friday, except on state holidays.
To contact the Secretary of State’s Notary Division, call (803) 734-2512. You may also contact the Division Director,
Tracy Sharpe, by email at tsharpe@sos.sc.gov.
4.
Please allow approximately 10 days for processing.
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