A. Personal Information (required before submitting) K.S.A. 53-102225Filing feeSubmit this form with the $25225PaymentPlease do not send cash. NOTICE: Credit card number Billing zip code Expiration date 225Appointment225Applicant nameK.S.A. 53-105225Residential addressK.S.A. 53-105a225Business address(Optional)225Seal/stamp impression K.S.A. 53-105225Daytime phone(Required)225Secondary phone(Optional)225Expiration date KANSAS SECRETARY OF STATE Notary PublicAppointment Form NO62-01must be completethe correct filing fee or the not Inst. 1 / 2Kansas Secretary of State. If renewing your notary appointment, please do not submit the appointment form until 90 days prior to your expiration date. The appointment form must be submitted by mail and must Please Do NotStaple Continue to next page American LegalNet, Inc. www.FormsWorkFlow.com B. Oath (Required before submitting) K.S.A. 53-102225SignatureK.S.A. 54-104225State/CountyK.S.A. 53-508225Date administeredK.S.A. 53-508225K.S.A. 53-508225K.S.A. 53-508C. Notary Surety Bond (Required before submitting) K.S.A. 53-102225Surety bondThe surety company must complete this section.225Surety name & address225Surety signatureAdditional Information: Please review the Kansas Notary Public Handbook for information regarding Kansas notaries.NC. KANSAS SECRETARY OF STATE Notary PublicAppointment Form NO62-01Inst. 2 / 2 Please proceed to form. Please Do NotStaple American LegalNet, Inc. www.FormsWorkFlow.com 1 / 2 Instructions: All information must be completed or this form will not be accepted. Secretary of State. If renewing your notary appointment, please do not submit the appointment form until 90 days prior to your expiration date. The appointment form must be submitted by mail and must include the A. Personal InformationPlease check one: � Previous name 2. Residential address 3. Business address 4. Daytime phone 5. Secondary phone 6. Expiration date of last Kansas appointmentFor reappointment only: Your current commission expiration date must be used until after the date of expiration has passed. KANSAS SECRETARY OF STATE Notary PublicAppointment Form � � � � NO62-01 Please Do NotStaple Continue to next page American LegalNet, Inc. www.FormsWorkFlow.com B. Oathswear*9. State ofCounty of11. My appointment expires:C. Notary Surety Bond 13. Name and address of surety company14. Signature of Attorney-in-FactDate Please review to ensure completion.2 / 2 American LegalNet, Inc. www.FormsWorkFlow.com