Application For Initial Appointment As A North Carolina Notary Public Form - 2001
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1
2OFFICE USE ONLY
State of North Carolina
__________
Department of the Secretary of State
NP#
__________
Elaine F. Marshall, Secretary of State
Examiner
__________
APPLICATION FOR INITIAL APPOINTMENT AS A
Proofed
NORTH CAROLINA NOTARY PUBLIC
BOTH SIDES OF FORM MUST BE COMPLETE AND LEGIBLE
PLEASE PRINT IN INK OR TYPE
ASSISTANCE:
The Notary Public Section is available for assistance from 8:00am to 5:00pm, Monday
through Friday, with the exception of holidays. You may contact us at (919) 807-2131.
FEE:
Make check or money order payable to NC Secretary of State in the amount of $50.00.
Fees are non-refundable (see N.C. Gen. Stat. § 10A-7). PLEASE DO NOT SEND CASH.
MAIL APPLICATION AND FEE TO:
Notary Public Section
Department of the Secretary of State
PO Box 29626
Raleigh, NC 27626-0626
1. Name of applicant as you wish to be commissioned
:
(Exact name and/or initials) (No nicknames)
EX: John Edward Doe OR
John E. Doe OR
J.E. Doe OR John Doe
2. Mailing Address:
City:
State:
Zip:
3. Residence Address (If different from mailing address): City:
State:
Zip:
4. Business Phone:
Home Phone:
Fax:
5. Social Security Number:
(
)
(
)
(
)
6. E-mail Address:
7. County of Residence:
8. Business / Employer Name: _____________________________________Occupation:______________________
Business Address:
__________________________________________________________________________
City / State / Zip Code: ________________________________________ County: _________________________
9. I hereby certify that the above named applicant has successfully completed the notary public education
course and therefore qualifies for your consideration for a notary public commission.
__________________________________________
_______________________________________________________ _________________
(signature of instructor)
(print or type name)
(date)
______________________________________________________________________________________________________
(name of community college)
10. I hereby recommend the commissioning of the applicant to serve as a notary public.
______________________________________
_______________________________________________________ _________________
(signature of elected official)
(print or type name)
(date)
_____________________________________________________________________
(title of elected official)
11. Are you a member of the North Carolina Bar?
Yes
No
(Practicing attorneys are exempt from taking the notary course; however, they are required to maintain a current notary guidebook.)
12. Do you have a current notary guidebook?
Yes
No
(N.C. Gen. Stat. § 10A-4 requires that you purchase and keep this as a reference.)
The Notary Public Guidebook may be purchased for $12.72 (including tax, shipping and handling) from:
The Institute of Government
CB#3330 Knapp Building
UNC – Chapel Hill
Chapel Hill, NC 27599-3330
919-966-4119
CONTINUED ON BACK OF FORM
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