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Print Reset Save Non-resident Notary Public Application ... library/nna/applications... · Instructions for Non-Resident Notary Commissioning Process M63458 1. Select Your Notary

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Page 1: Print Reset Save Non-resident Notary Public Application ... library/nna/applications... · Instructions for Non-Resident Notary Commissioning Process M63458 1. Select Your Notary

Have you ever been a notary public in this or any other state? � Yes � NoIf yes, list the states: ______________________________________________________________________________________________________________

NOTARIAL OATH State of Illinois, County of____________________________________I do solemnly affirm, under the penalty of perjury, that the answers to all statements on this application are true, complete and correct; that I have carefully readthe notary law of the State of Illinois; and that if appointed and commissioned as a notary public, I will perform faithfully, to the best of my ability, all notarial acts inaccordance with the law. Further, my signature below authorizes the Office of the Secretary of State to conduct a background verification to confirm the assertionsand information provided herein.Printed Name as you want commissioned ________________________________________________________________________Signature of Applicantas Printed Above __________________________________________________________________________

Notary Public Signature:_____________________________________________________________________

Witnessed and Affirmed this ____________ day of _______________________________, 20 _____________

AFFIX NOTARY SEAL HERE

NOTARY PUBLIC BONDTHIS BOND MUST BE WRITTEN BY A COMPANY QUALIFIED WITH THE ILLINOIS DEPARTMENT OF INSURANCE TO WRITE SURETY BONDS IN THESTATE OF ILLINOIS. The Office of the Secretary of State does not recommend any particular bonding or insurance company.

Know all by these presents that we ________________________________________________________________________________as principal/applicant and____________________________________________________________________ are held firmly bound unto the People of the State of Illinois, in the penalsum of FIVE THOUSAND DOLLARS ($5,000), for the payment of which, well and truly to be made, we bind ourselves, our heirs, executors, administrators andassigns jointly and severally, firmly by these presents.

THE CONDITION OF THE ABOVE OBLIGATION IS SUCH THAT, whereas, the above bound principal/applicant has applied for appointment by the Secretary ofState of the State of Illinois as a Notary Public for a one-year term.

Now, if said principal/applicant shall truly and faithfully perform and discharge the duties of said office of Notary Public, in all things according to law, then theabove obligation to be null and void, otherwise to remain in full force and virtue in law. The term of this bond is from the effective date of the principals’s/applicant’scommission to the expiration date of the same.

x ______________________________________________________ x ______________________________________________________ Signature of Principal/Notary Public Applicant Signature of Authorized Representative of Surety Company

BOND NUMBER AFFIX CORPORATE SEAL HERE

Non-resident Notary Public ApplicationJesse White — Illinois Secretary of State

Enclose $10 fee payable to Secretary of State. Return completed form to: Secretary of State Index Department, 111 E. Monroe, Springfield, IL 62756.

Printed by authority of the State of Illinois. March 2016 — 1— I 172.3

1. I am a U.S. citizen or an alien admitted for permanent residence.2. I have worked or maintained a business in Illinois for 30 days.3. I am age 18 or older.

4. I have never been convicted of a felony.5. I am able to read and write the English language.6. I have never had a notary public commission revoked in the last 10 years.

Last Name: First Name: Middle Name or Initial:

Name of Business Employer: Driver’s License or State ID Card Number (attach a photocopy): Business Address (P.O. Box not acceptable):Street: City: State: ZIP Code:

Business Telephone Number: Date of Birth: Applying for: � New Commission � Renewal of Commission Current Expiration Date: _________ Commission Number: ____________ County of Business: Home Phone:

Home Address (P.O. Box not acceptable):Street: City: State: ZIP Code:

Has your name, address or county changed since your last commission? � Yes � NoIf yes, give previous name, address and/or county: ______________________________________________________________________________________

Print Reset Save

Merchants Bonding Company (Mutual)

Return completed form to: The NNA, 9350 De Soto Avenue, Chatsworth, CA 91311-4926

Page 2: Print Reset Save Non-resident Notary Public Application ... library/nna/applications... · Instructions for Non-Resident Notary Commissioning Process M63458 1. Select Your Notary

Instructions for Non-Resident Notary Commissioning Process

M63458

1. Select Your Notary PackagePlease select an NNA® supplies package, which includes your state application fee, state-required Notary bond, official Notary seal stamp, and more.

2. Complete and Submit Your Notary Public Application and Bond Form

Application:

Fill out this section completely. Do not use whiteout to correct mistakes. If necessary, line-through any mistakes. Write ‘N/A’ or ‘Self Employed’ for business address, if none.

IMPORTANT: Include a legible photocopy of your valid Driver’s License or state identification card, front and back. Your home address must match your Driver’s License. If you have registered a change of address online, please note. If you need to update your address, visit http://cyberdriveillinois.com/.

Provide at least one phone number.

Notarial Oath:

Print your county of business.Please print your name. Proper format is first name or initial, middle name or initial (optional), and last name as shown on your driver’s license or ID card. This is how your name will appear on your commission certificate. In the presence of a current IL Notary, sign the notarial oath. Signature must match printed name.

Notary Public Bond:

Print your name.

Sign your name here, as you printed and signed on the Notarial Oath. Your signature must match - abbreviations cannot be used.

Leave this blank. The Bond Number will be completed by our office.

3. Payment and Application SubmittalForward an original Application/Bond form, not a copy, with your payment and ID photocopies to:

National Notary Association 9350 De Soto Avenue

Chatsworth, CA 91311-4926

If ordering by mail or fax, include your order form, noting your choice of package. All packages include the $10 State Application Fee — a separate check is not required.

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© 2018 National Notary Association

Important!

þDo not leave any blank spaces.

þ Do not use whiteout. Line-through and correct any mistakes.

þ Include a copy of a valid Driver’s License, front and back.

þ Have your application notarized.

þ IA, KY, MO & WI residents only.

Have you ever been a notary public in this or any other state? � Yes � NoIf yes, list the states: ______________________________________________________________________________________________________________

NOTARIAL OATH State of Illinois, County of____________________________________I do solemnly affirm, under the penalty of perjury, that the answers to all statements on this application are true, complete and correct; that I have carefully readthe notary law of the State of Illinois; and that if appointed and commissioned as a notary public, I will perform faithfully, to the best of my ability, all notarial acts inaccordance with the law. Further, my signature below authorizes the Office of the Secretary of State to conduct a background verification to confirm the assertionsand information provided herein.Printed Name as you want commissioned ________________________________________________________________________Signature of Applicantas Printed Above __________________________________________________________________________

Notary Public Signature:_____________________________________________________________________

Witnessed and Affirmed this ____________ day of _______________________________, 20 _____________

AFFIX NOTARY SEAL HERE

NOTARY PUBLIC BONDTHIS BOND MUST BE WRITTEN BY A COMPANY QUALIFIED WITH THE ILLINOIS DEPARTMENT OF INSURANCE TO WRITE SURETY BONDS IN THESTATE OF ILLINOIS. The Office of the Secretary of State does not recommend any particular bonding or insurance company.

Know all by these presents that we ________________________________________________________________________________as principal/applicant and____________________________________________________________________ are held firmly bound unto the People of the State of Illinois, in the penalsum of FIVE THOUSAND DOLLARS ($5,000), for the payment of which, well and truly to be made, we bind ourselves, our heirs, executors, administrators andassigns jointly and severally, firmly by these presents.

THE CONDITION OF THE ABOVE OBLIGATION IS SUCH THAT, whereas, the above bound principal/applicant has applied for appointment by the Secretary ofState of the State of Illinois as a Notary Public for a one-year term.

Now, if said principal/applicant shall truly and faithfully perform and discharge the duties of said office of Notary Public, in all things according to law, then theabove obligation to be null and void, otherwise to remain in full force and virtue in law. The term of this bond is from the effective date of the principals’s/applicant’scommission to the expiration date of the same.

x ______________________________________________________ x ______________________________________________________ Signature of Principal/Notary Public Applicant Signature of Authorized Representative of Surety Company

BOND NUMBER AFFIX CORPORATE SEAL HERE

Non-resident Notary Public ApplicationJesse White — Illinois Secretary of State

Enclose $10 fee payable to Secretary of State. Return completed form to: Secretary of State Index Department, 111 E. Monroe, Springfield, IL 62756.

Printed by authority of the State of Illinois. March 2016 — 1— I 172.3

1. I am a U.S. citizen or an alien admitted for permanent residence.2. I have worked or maintained a business in Illinois for 30 days.3. I am age 18 or older.

4. I have never been convicted of a felony.5. I am able to read and write the English language.6. I have never had a notary public commission revoked in the last 10 years.

Last Name: First Name: Middle Name or Initial:

Name of Business Employer: Driver’s License or State ID Card Number (attach a photocopy): Business Address (P.O. Box not acceptable):Street: City: State: ZIP Code:

Business Telephone Number: Date of Birth: Applying for: � New Commission � Renewal of Commission Current Expiration Date: _________ Commission Number: ____________ County of Business: Home Phone:

Home Address (P.O. Box not acceptable):Street: City: State: ZIP Code:

Has your name, address or county changed since your last commission? � Yes � NoIf yes, give previous name, address and/or county: ______________________________________________________________________________________

Print Reset Save

Merchants Bonding Company (Mutual)

Return completed form to: The NNA, 9350 De Soto Avenue, Chatsworth, CA 91311-4926

Jones

305-555-3962

L252-067-86-945-3

Pat R. Jones

Pat R.C

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234 West Main Street

Pat R. Jones

Chicago

Kenosha

IL

WA

60007

53104

ABC Bank

xn/a n/a11/15/64305-555-1212

8524 Mason Road

Cook

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xCook

12 March 18

OFFICIAL SEALJAMES K. HAWKINS

Notary Public, State of IllinoisMy Commission Expires Jan 30, 2021

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