Transmittal Information For All Notary Filings - Louisiana Secretary Of State Page 4
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SECTION THREE
XEMPTION
ROM
XAMINATION
Office use
(check only one)
La. R.S. 35:191(C)(2)(c) or La. R.S. 35:191(E)
Status verified by:
Applicant is duly licensed to practice law in the State of Louisiana, and is
Attorney admitted to the
exempt under R.S. 35:191(C)(2)(c) from taking or passing the Louisiana state
practice of Law in the State
notary examination provided for in R.S. 35:191.1.
Approval Date:
of Louisiana
Status verified by:
Notary currently
Applicant currently holds a valid commission as a notary public in the State of
Louisiana in and for the Parish of _____________________, and is exempt
commissioned in the State
under R.S. 35:191(C)(2)(e) from taking the Louisiana state notary examination
of Louisiana seeking a dual
Approval Date:
provided for in R.S. 35:191.1.
commission
Applicant holds or has held a valid commission in and for the Parish of
Status verified by:
Notary/Attorney Notary
_________________, and is changing his residence/office location to
currently commissioned in
_________________ parish, and is exempt under R.S. 35:191(E) from taking
the State of Louisiana
or passing the Louisiana state notary examination provided for in R.S. 35:191.
Approval Date:
changing parish of
residence
E
R
– La. R.S. 35:191.(C)(2)(b)
XAMINATION
EQUIRED
The undersigned applicant declares that he has met the requirements for
Status verified by:
appointment to the office for which he has applied and hereby requests
New Applicant
approval to register to take the Louisiana state notary public examination
Examination Registration
provided for in R.S. 35.191.1
Approval Date:
Examination Registration requires a separate $75 examination fee
SECTION FOUR
S
A
TATEMENT OF
PPLICANT
STATEMENT of APPLICANT
I, _____________________________, herein applying to qualify for appointment to the office of Notary
Public in and for the Parish of __________________________, do state that the information contained in this
application and in all supplemental forms and attachments hereunto are true and complete and given for the purpose of
obtaining appointment to the office Notary Public under the provisions of R .S. 35 et seq.
________________________________________________
Applicant signature
________________________________________________
Applicant printed name
Page 3
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