Fillable Application Form For Notary Public Commission printable pdf download

MAIL APPLICATION, APPLICATION FEE, AND COPIES OF ID,

TRAINING AND TESTING CERTIFICATES TO:

COLORADO SECRETARY OF STATE

Notary Program

1700 Broadway, Suite 200

Denver, CO 80290

303-894-2200

Office Use Only

APPLICATION FOR NOTARY PUBLIC COMMISSION

. A

LEASE TYPE OR PRINT LEGIBLY

LL SECTIONS MUST BE COMPLETED

Print your legal name. This name will appear on your commission certificate and must be on your seal.

Middle/Init (opt):

Current or prior commission

Last Name:

First Name:

Suffix:

expiration date:

Residence Address 1: A physical address is required.

Home Phone Number:

Address 2:

City:

Zip Code:

PO Box

(If applicable)

PO Box City:

PO Box Zip Code:

Email Address:

Business Address 1: If employed, this is required. If not employed, write “None”.

Business Phone Number:

Business Address 2:

City:

Zip Code:

AFFIRMATION

solemnly affirm, under the penalty of perjury in the second degree, as defined in section 18-8-503,

Colorado Revised Statutes, that I have carefully read the notary law of this state, and, if appointed and commissioned as a notary public, I will

faithfully perform, to the best of my ability, all notarial acts in conformance with the law.

Check only one:

I am a United States Citizen, OR

I am a Permanent Resident of the United States, OR

I am lawfully present in the United States pursuant to Federal law.

I understand that this sworn statement is required by law because I have applied for a public benefit. I understand that state law requires me

to provide proof that I am lawfully present in the United States prior to receipt of this public benefit. I further acknowledge that making a false,

fictitious, or fraudulent statement or representation in this sworn affidavit is punishable under the criminal laws of Colorado as perjury in the

second degree under Colorado Revised Statute 18-8-503 and it shall constitute a separate criminal offense each time a public benefit is

fraudulently received.

I am a Colorado Resident and 18 years of age or older.

I have never been convicted of a felony.

I have not been convicted of a misdemeanor involving dishonesty as defined in C.R.S. 12-55-102(1.4) during the last five years.

I am able to read and write the English language.

My commission as a notary has never been revoked.

(Applicant must sign and date in front of a notary public.)

_________________________________________________________

_________________

Official Signature of Applicant

Date

Subscribed and affirmed before me this ________ day of ________________ , 20_____ ,

in the county of ____________________ , State of Colorado.

______________________________________________

______________________

Signature of Notary Public or other Qualified Officer

Commission Expiration Date

Seal

To receive your certificate,

Applications paid by check for new and renewing notaries take longer to process. For faster processing upon receipt

see instructions on page 2.

of your application documents in our office, and a lower fee, please file electronically at the Secretary of State’s website.

Application Form For Notary Public Commission

Related Articles

Related forms

Related Categories