Application For Notary Public Page 2
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1
2Arkansas Secretary of State
Mark Martin
State Capitol • Little Rock, Arkansas 72201-1094
501-682-3409 •
Business & Commercial Services, 1401 W. Capitol, Suite 250, Little Rock, AR
APPLICATION FOR NOTARY PUBLIC
☐
☐
Check one:
New
Renewal (Print Commission Number):
Return the following materials to the Arkansas Secretary of State:
•
Completed Application: Please write your name each time exactly as it appears on your bond. Affidavit must be completed by
notary or other authorized official other than yourself.
•
$20.00 Application Fee: Check or money order made payable to the Arkansas Secretary of State.
•
Copy of Surety Bond or Contract: A $7,500 bond may be purchased from a bond or insurance company of
your choice authorized to do business in Arkansas. Enclose a copy of the bond, not the application for the bond.
Applicant’s Name (Print or type name as it appears on your bond):
Residential Address:
Physical Address (No Post Office Box):
City:
State:
Zip:
County:
Email:
Phone:
Mailing Address if different from above residential address:
Address:
City:
State:
Zip:
County:
Employer’s Address if above residential address is out of state:
Physical Address (No Post Office Box):
City:
State:
Zip:
County:
Please verify the following by checking the boxes below:
☐
I am eighteen (18) years of age or older.
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I am a bona fide citizen of the United States or a permanent resident alien (if resident alien, recorded Declaration of
Domicile is attached).
☐
I am a legal resident of Arkansas or of an adjoining state and employed in Arkansas.
☐
I am able to read and write English.
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I have not had my commission as a notary revoked during the past ten (10) years.
☐
I have never been convicted of a felony.
☐
I have reviewed the law concerning notaries public and understand the duties of a notary public.
AFFIDAVIT
I, the undersigned, being first duly sworn, respectfully make application as an Arkansas notary public for a commission of ten (10)
years and further state under oath that the information contained in this application is true and correct.
Signature (as it appears on your bond)
Date
State of Arkansas, County of
On this the
day of
, before me,
, the undersigned notary,
, 20
personally appeared
known to me (satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that he/she executed the same for the purposes therein contained.
In witness whereof I hereunto set my hand and official seal.
[Notary Seal]
Notary Public:
My commission expires:
Fee: $20.00
Rev. 07/13
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