Application For Reappointment As A Notary North Carolina Notary Public Form - 2001

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OFFICE USE ONLY
State of North Carolina
__________
Department of the Secretary of State
NP#
__________
Elaine F. Marshall, Secretary of State
Examiner
__________
APPLICATION FOR REAPPOINTMENT 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.
Name on last commission:
______________________________________________________
PLACE YOUR STAMP
OR SEAL HERE
Expiration date of last commission:________________________
(If commission has been expired for 5 years or more, applicant must complete
the notary public course and use an initial appointment application.)
County of last commission: ______________________________
If you have changed your name or county of residence
since your last commission, please indicate so here.
CHANGE OF NAME AND/OR COUNTY: You must purchase a new stamp/seal to correspond
with your name/county on your new commission.
10. Have you attended a notary class or workshop?
Yes
No
If Yes:
__________________________________________ _______________________
________________
(Community College at which you attended the course)
(Instructor)
(Date attended)
The Community Colleges throughout North Carolina are now offering courses of study for notaries. If you have not
attended one of these courses, we strongly urge you to contact the college of your choice for
information and enroll in one of these classes.
11. Are you a member of the North Carolina Bar?
Yes
No
(Practicing attorneys, although exempt, are highly recommended by the Secretary of State to take the notary public course.
They are required to maintain a current notary guidebook. )
CONTINUED ON BACK OF FORM

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