Arkansas Secre t a ry of State Charlie Daniels State Capitol • Little Rock, Arkansas 72201-1094 501-682-3409 • www.sos.arkansas.gov Business & Commercial Services, 250 Victory Building, 1401 W. Capitol, Little Rock Instructions: Return to the Arkansas Secretary of State the following materials: Completed Application Certificate to be completed by notary or other authorized official other than yourself $20.00 application fee, Check or money order made payable to Secretary of State Copy of surety bond or contract. The bond may be purchased from a bond or insurance company of your choice. Enclose a copy of the actual bond and not the application for the bond. Name: Each time your name appears, it must be exactly the same as the name on your bond. Application for Notary Public I, ________________________________ state that I am: (Print or type name as printed on your bond) •A bona fide citizen of the United States or a permanent resident alien (recorded Declaration of Domicile attached); • A legal resident of Arkansas or of an adjoining state and employed in Arkansas; • 18 years of age or older; • Able to read and write English; and • That during the past 10 years have not had my commission as a notary revoked. ______________________________________________________________________________________________________________________ Address of Residence (No Post Office Box) City State Zip County _______________________________________________________________________________ Address of Employment, if not Arkansas Resident City State Zip County Address to which you would like your commission and oath mailed, if different from above: _______________________________________________________________________________ Address City State Zip Now therefore, I respectfully make application as an Arkansas Notary Public for a commission of 10 years and further state under oath that the information contained in this application is true and complete. _________________________ (Signature as printed on your bond) ________ Date ____________________________________ Commission number (if applicable for renewing notaries) Certificate State of Arkansas County of _________________ Subscribed and sworn to before me on the _______ day of_________________, _________. ___________________________________ Signature of Notary Public or other authorized official American LegalNet, Inc. www.FormsWorkFlow.com