600 STATE OF IDAHO APPLICATION FOR APPOINTMENT AS NOTARY PUBLIC PLEASE READ CAREFULLY AND COMPLETE ALL ITEMS. FAILURE TO COMPLETE THE ENTIRE FORM WILL CAUSE REJECTION OF YOUR APPLICATION. Mail to: Secretary of State, Notary, P.O. Box 83720, Boise, Idaho 83720-0080. I, _________________________________ , hereby apply for appointment to a commission as Notary Public for the State of Idaho. I make the following statements in support of the application: (1) I am on this date at least eighteen (18) years of age. (2) My gender is Male Female (check appropriate box). (3) Former Name (if you have previously been commissioned in Idaho under another name): _________________________________ (4) Have you previously been commissioned in Idaho?: No Yes If so, what is the State file number (5) I reside at: _______________________________________________________________________________________________ (Street Address) __________________________________________________________________________________________________________ (City) (State) (Zip Code) (Day Time Phone Number) (6) If I am not a resident of Idaho, I am employed or doing business in Idaho at ____________________________________________ (Business Name) __________________________________________________________________________________________________________ (Street Address) (City) (State) (Zip Code) (7) The mailing address to which the certificate should be sent (if different from (5)) is:____________________________________ (Business Name) __________________________________________________________________________________________________________ (Street Address or P. O. Box) (City) (State) (Zip Code) (8) Name, address and phone number of insurance agency writing the new notary bond: ___________________________________ (Name of Agency) __________________________________________________________________________________________________________ (Address) (City) (State) (Zip Code) (Phone Number) (9) Name of bonding company and bond number for new bond: _______________________________________________________ (Company) (Bond Number) (10) I am able to read and write the English language. (11) I have not been convicted of a serious crime nor removed from the office of Notary Public for official misconduct within the past ten (10) years. NOTE: If the applicant cannot truthfully make the statements in Items (1), (6), (10), and (11) above, he or she is ineligible to hold the office of Notary Public, and should proceed no further with this application. APPLICANT: Affix specimen of your seal here (Rubber Stamp Seal can be purchased from office supply, stationery or stamp company) (SEAL) OATHOFOFFICE I______________________________, solemnly swear (or affirm) that the answers to all questions in this application are true, complete and correct; that I have carefully read the notary laws of this State and I am familiar with their provisions; that I will uphold the Constitution of the United States and the Constitution and laws of the State of Idaho; and I will faithfully perform, to the best of my ability, the duties of the office of Notary Public. State of Idaho ) County of ________________) ss Subscribed and sworn (or affirmed) before me this _____ day of _________________ , 20___. Applicant signature FOR SECRETARY OF STATE'S OFFICE USE ONLY Notary Public signature My commission expires on_____________, 20__ . DETACH AND RETURN THIS FORM ALONG WITH THE $30.00 FILING FEE AND ORIGINAL NOTARY BOND. American LegalNet, Inc. www.FormsWorkflow.com K:\Debbie\Notaries\Notary Application Modified.PMD August 2006 August 2004