MISSISSIPPI SECRETARY OF STATE POST OFFICE BOX 136 JACKSON, MISSISSIPPI 39205-0136 APPLICATION FOR REPLACEMENT COMMISSION This application must be typed or printed in ink. This form is designed to be completed and printed from your computer. You will not be able to save the form on your computer unless you have the appropriate software. Return completed Application, together with the $20.00 fee to the Secretary of State's Office. The undersigned Notary, hereby, notifies the Secretary of State of the need for a replacement Commission: ______________________________________________, (Type or print name exactly as it appears on your Commission) _________________, (Commission expiration date) _______________ (Notary ID Number) A replacement Commission is needed as a result of the following: Commission Certificate has been lost or destroyed; Seal has been lost or stolen; or Other Commission Certificate or Seal has been stolen, please attach a copy of the Police Report. The replacement certificate will be mailed to the address of record. This the ________ day of ______________, 20_______. __________________________________________ Signature of Notary American LegalNet, Inc. www.FormsWorkFlow.com SOS FORM NP 006 April, 2007 PAGE 1 of 1 Pages