Wyoming Notary Public Commission Application
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1Wyoming Notary Public Commission Application
Instructions
Type or print clearly, filling in all blanks. Incomplete or illegible forms may be returned.
:
1. Commission Name Style (type or print name to exactly match signature below)
2. County of Residence
3. Gender
4. Last Name
5. First Name
6. Middle Name
Male
Female
7. Residential Address (street/route)
8. City
9. Zip Code
10. Home/ Cell Phone
11. Mailing Address (where notary information will be mailed)
12. City
13. Zip Code
14. Name of Employer
15. Business Phone
16. Address of Employer
17. City
18. Zip Code
19. I am applying for:
A new commission; or
A renewal of my current commission. My current commission expiration date is: ___________________
20. Have you ever been a Wyoming notary?
Yes, under the name of ______________________________ in ________________________ County.
No.
Certification:
Please check all that apply, then sign (as shown in Item #1) and date the application.
I certify that:
1)
I am 18 years of age or older.
2)
I am able to read and write the English language.
3)
I am a resident of the State of Wyoming and of the County for which I am making an application.
4)
I have not been convicted of a felony or
5)
I have been convicted of a felony and my felony conviction has been:
R
;
eversed or annulled
P
ardoned; or
A
ll rights have been restored pursuant to W.S. 7-13-105(a).
I further certify that I understand the duties and responsibilities imposed on notaries public under Wyoming
law and understand that breach of said responsibility may result in criminal penalties including imprisonment.
_______________________________________
_____________________________
Signature of Applicant (must match Item #1 above)
Date
Filing Fee: $30.00 (make checks payable to “Secretary of State”)
Submit application and filing fee to:
Ed Murray
Secretary of State
Attn: Notary Officer
2020 Carey Ave, Ste 700
Cheyenne, WY 82002-0020
Ph. 307.777.7370
Revised 11/2015
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