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Notary Public Application Form. This is a Delaware form and can be use in Notary Public Department Of State.
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Tags: Notary Public Application, Delaware Department Of State, Notary Public
DELAWARE NOTARY PUBLIC APPLICATION
Notaries Public are appointed by the Governor pursuant to 29 Del. C. Chapter 43. The requirements are found at
http://notary.delaware.gov/services/npinstru.shtml. Please read the requirements before completing the application. Your
application will not be accepted unless ALL areas are completed.
PLEASE PRINT OR TYPE
(Select one:)
Miss
Mrs.
Ms.
Mr.
Name of applicant ______________________________________________________ Birthdate: ______________
(First/Middle/Last)
(Month/Day/Year)
Home Address ________________________________________________________________________________
(City)
(Street)
(State)
(County)
(Zip)
If you have ever been convicted of a crime (except for minor traffic violations), please list offense, date, and state.
____________________________________________________________________________________________
Delaware resident
non-resident, State of __________________ (non-resident who maintains a Delaware
workplace must fill out “Affidavit of
Non-resident Applicant” form)
Request for new appointment (2 year term only - $60)
Request for reappointment – present Commission expires on: ___________
2 year term ($60) or
4 year term ($90)
With what business organization are you associated?
Business Name: ______________________________________________________________________________
Business Address _____________________________________________________________________________
City _________________________________State ___________ Zip ________ Telephone: __________________
State the nature of your business and the reasons that a notary public commission in your name is needed.
Give the names, home addresses, and telephone numbers of two legal residents of Delaware (not related to you)
who are qualified as references with respect to your character and reputation:
____________________________________________________________________________________________
(Name)
(Street)
(City)
(Zip)
(Telephone No.)
____________________________________________________________________________________________
(Name)
(Street)
(City)
(Zip)
(Telephone No.)
________________________________________
Signature of Applicant
(Do not write in this space) Official Use Only
#________________________ Date: _____________
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