Revised 6/2011 NOTARY DIVISION OFFICE OF THE SECRETARY OF STATE, STATE HOUSE, ANNAPOLIS, MARYLAND 21401 Email: notary@sos.state.md.us or call (888) 874-0013 TYPE OF APPLICATION: NEW __ RENEWAL __ Note: If renewing, place notary seal next to the “Office Use Only” box. PLEASE READ APPLICATION CAREFULLY AND PRINT CLEARLY. FAILURE TO PROVIDE ALL OF THE INFORMATION REQUESTED WILL RESULT IN THE DENIAL OF YOUR APPLICATION WITH NO FURTHER CONTACT FROM THIS OFFICE. To apply for your Maryland notary public commission, complete and return this application to the above address along with a copy of your driver’s license or valid photo I.D. that verifies residency and a non-refundable $20.00 fee by check or money order made payable to the Secretary of State. Please note that applications not accompanied by the $20.00 processing fee will NOT be processed. Please do NOT staple your fee to this application. There will be a $25.00 fee for all returned checks. Any questions email us at notary@sos.state.md.us or call (410) 974-5520. Senator: Subject to the provision of State Government Article of the Annotated Code of Maryland, I hereby make application for the appointment of a Notary Public. I certify that I am at least 18 years of age, of good moral character and integrity, and that I ___ live and/or ___ work in the State of Maryland. A notary may be removed or suspended from office for incompetency or misconduct. Maryland Residents: Call the Elections Office in the county in which you reside or City of Baltimore or visit the website: www.mdelect.net to find the information requested below, and complete the following: I am a resident of the _____ Legislative District, ______________________ County or Baltimore City____, represented by State Senator ____________________. Non-Residents: I request to be commissioned in _________________________County or Baltimore City____.  Please check the box to the left if you do not want your name and email shared with businesses. **Please Print all information: Legal name as it should appear on your commission. Date of Birth: Permanent Home Address, City, State, Zip Home Phone: Email: Name of employer Address, City, State, Zip Phone number Self-employed/occupation Address, City, State, Zip Work number Have you ever had a Notary Public commission revoked in any state? Yes___ No___ If yes, please explain: Have you ever been convicted of a crime or had any civil judgments against you? Yes___ No___ If yes, please explain the nature of offense and/or civil judgment and the date of occurrence. If extra space is needed, attach separate sheet of paper. If you have changed your name since you were commissioned, indicate old name ________________________________ If your address changed since you were commissioned, indicate new county if this applies: New county __________________ -OVER- References: List 3 people that are Maryland residents (not family members or employer) who may be contacted to attest to your character. (Optional for renewals) Name: Email: Street Address: Phone: Female  Male  Female  Male  Maryland Male  City:  Female Zip: Name: Email: Street Address: Phone: City: Maryland Zip: Name: Email: Street Address: Phone: City Maryland Zip: PLEASE READ AND INITIAL EACH STATEMENT. A Maryland Notary Public must be familiar with and understand “The Handbook for Maryland Notaries Public” in its entirety. The handbook is located at the following website: www.sos.state.md.us A notary must always be completely satisfied with the identity of the person whose signature is being notarized. A notary is not obligated to notarize a person’s signature without being sure that the person is who he or she claims to be. Always check identification and be satisfied that the ID is valid. A notary is not authorized to perform marriages, certify birth, marriage/death certificates or any act that constitutes the practice of law. A notary is not an attorney and cannot practice as one. A notary must notify the Secretary of State of any changes to the information provided on this application in writing. A notary must always keep a fair registry book no matter how many or few notaries they perform. A notary must contact the notary division if you are performing e-notarizations. Additional information must be provided. Call or email office at 410-974-5520 or notary@sos.state.md.us . Do you read and write English? Yes ___ No ___. If no, please specify your primary language_________ Are you a registered voter in Maryland? Yes____ No____. If no, what state? _________________ The maximum fee by law a notary can charge is $2.00 per notarial act. You will receive a postcard notifying you to pick up your commission at the Circuit Court in your county. When you receive the postcard, you must appear before the Clerk of the Circuit Court within 30 days to be sworn in for your new term. Failure to be sworn in within 30 days will result in the revocation of the appointment and commission. You will pay the Clerk a commissioning fee of $11.00 ATTACH A COPY OF DRIVER’S LICENSE OR VALID PHOTO I.D. THAT VERIFIES RESIDENCY AND THE FEE WITH APPLICATION I SOLEMNLY AFFIRM under penalties of perjury and upon personal knowledge that the contents of this application are true. Signature Date For Senator Use References contacted? __Y __N Background checked? __ Y __N APPROVED ____ Verified employment? __Y __N DENIED ____ __________________________________________________________________ SENATOR’S SIGNATURE _________________________________________________________________ State Senator Legislative District Date For renewals, place seal here American LegalNet, Inc. www.FormsWorkFlow.com