Name And Address Change Form Page 2
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58. _______________________________________________________________________________________________________
Applicant’s Employer/Business Name
9. _______________________________________________________________________________________________________
Employer/Business phone number at the location where you work
10. _______________________________________________________________________________________________________
Employer/Business complete physical address at the location where you work (No P.O. Boxes)
11. To be commissioned as a notary public, a person
Shall be at least 18 years of age.
Shall reside legally in the United States.
May not, within 10 years before the commission takes effect, have been convicted of a felony or incarcerated in a
correctional facility for a felony conviction.
May not, within 10 years before the commission takes effect have had a notary public commission revoked for failure
to comply with notary law or for incompetence or malfeasance in carrying out the duties of notary public.
Shall have established residency in this state by being physically present in the state with the intent to remain
indefinitely and by maintaining a place of abode in the state.
12. Oath
I do solemnly swear (or affirm) that I will support and defend the Constitution of the United States and the
Constitution of the State of Alaska and that I will faithfully discharge my duties as notary public to the best of
my ability. The information provided on this application form is truthful and accurate and I meet all of the
requirements to be commissioned an Alaska Notary Public. I acknowledge that I am personally liable for
every notarial act that I perform.
_________________________________________________
Applicant’s Notarized Signature
Subscribed and sworn (or affirmed) to before me by ___________________________________________ this ________ day of
_______________________, __________.
_________________________________________________
Notary Public’s Signature
My Commission Expires:____________________________
12/27/05
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