Application For Appointment - Notary Public - Special Commission Page 2
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2SPECIAL COMMISSION NOTARY PUBLIC APPLICATION FOR APPOINTMENT
INSTRUCTIONS BY LINE
Line 1
Print or type name as it is to appear on the Certificate of Appointment, it must match your signature.
Line 2
Date of birth including year.
Line 3
Daytime phone number.
Line 4
Home address where your Oath of Office & Certificate of Appointment will be mailed.
Line 5
County of Commission - If a Kentucky resident, this is the county where the applicant resides. If a non-resident, the
Kentucky county from which the application is being made. (The county on this line should match the county of the
official signature at the bottom on the “Certificate of Approval”.)
Line 6
Check this box if you would like your address to be published on the notary website.
Certificate of Approval must be signed by one of the listed officials BEFORE mailing to Notary Commissions – the
county of the official signature should match the county listed on line 5.
Print or type email address to receive future notary reminders such as renewal notices.
Signature of applicant – the application is not complete until signed and matches name listed on line 1.
Please mail application along with the fee of $10 to:
Notary Commissions
PO Box 821
Frankfort, Kentucky 40602-0821
You are applying for appointment to the office of Notary Public - Special Commission. A Notary Public - Special
Commission is a resident or nonresident of Kentucky, who is appointed by the Governor of Kentucky to perform notarial
acts in or outside this state covering writings prepared for recordation in this state. KRS 423.110(6). Notaries receiving
the appointment to this office are specifically limited to the acts described in this paragraph.
After the application has been filed and approved by the Secretary of State, you will receive a Notice of Appointment.
Attached to the Notice of Appointment will be a printed Oath of Office. Pursuant to KRS 62.010, you must take the Oath
of Office within thirty (30) days after you receive your Notice of Appointment. After the oath has been administered,
the written Oath of Office must be returned to the Secretary of State within thirty (30) days from the date of your
Notice of Appointment letter. Upon receipt by the Secretary of State of the Oath of Office, the Governor, through the
Secretary of State, will issue to the applicant the Commission to Office. Failure to return the Oath of Office will cause
your commission to become void. This will necessitate the submission of a new application and fee to become a
commissioned notary.
(01/12)
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