State of North Carolina Department of the Secretary of State Elaine F. Marshall, Secretary of State APPLICATION FOR REAPPOINTMENT AS A NORTH CAROLINA NOTARY PUBLIC (Revised April 2018 ) Read the instr uctions completely before filling out this application . Please print in black ink or type answers. ull Legal Name ( F ull name with no initials ) Gender: M F Reappointment Applicants Plac e Current Notary Seal Here Do not purchase a new seal until you take the new oa th * * You may use one initial for the first or m iddle name but not for both. Commission n ame may be a part of your full lega l name, but not a nickname or shortened version of your legal name. No single initi als without a full first or middle name are permitted. This name is how you will be commissioned and must appear exactly as such on your seal. 3. Name on Last Commission / Expiration Date / County 4.Mailing Address: City: State: Zip: Residence Address if Different: City: State: Zip: 5.Business Phone + ext : Home /Cell Phone: 6.Last 4 Digits SSN#:7 .Are you a citizen of the United States? Yes No If n o, see instructions on the following page . 8 . Home Email Address: Business Email Address: 9.Birth Date : 10.County of Residence : 11. Occupation : OR Unemployed Retired Student Self - Employed Business / Employer : C ounty Where Employed : Business Mailing Address : (Address,City,State, Zi p) 12. Complete this section only if you chose to attend a notary class in lieu of taking the online notary exam. N ame of community college or educational organizati on P rint or type name of instructor D ate complete d Number of class hours I hereby certify that the above named applicant has successfully completed the notary p ublic education course and there fore qualifies for your cons ideration for a notary p ublic commission. (S ignature of instructo r is required for applicants who take the course prior to reappointment ) S ignature of instructor D ate signed 13.Were you commissioned on or before July 10, 1991? Yes No If Yes, has your commission been continuous since your initial appointment? Yes No Have you No 14.Are you a licensed member of the 15.Do you speak, read and write the 1 6 .Do you have a current NC N otary Public Manual? N.C. State Bar? Yes No English language? Yes No Yes No If yes: Year 1 7 .Have you ever been conv icted by any court of a felony or misdemeanor? Have you been charged with an offense for which trial is still pending? Yes No If yes to either question , see instructions on following page . 1 8 . Have you ever had a professional license or n otary commission denied, revoked, restricted or suspended? Have you ever had to resign a license or commission under unfavorable circumstances? Yes No If yes to either question, see instructions on following page. 1 9 . I, , solemnly swear or affirm under penalty of perjury that the information in (appl this application is true, complete and correct; that I understand the official du ties and responsibilities of a notary p ublic in this State, as described in the statutes; that I can speak, read and write in the English language; and that I will perform to the best of my ability all notarial acts in accordance with the law. Signature of Applicant : (This signature must be signed before a notary an d match the name on line 2 above. This signature must be used when performing ALL notarial acts .) *************************************************************************************************** ****** **************************************************** **************************** * DO NOT NOTARIZE YOUR OWN SIGNATURE. 20. This certificate must be notarized by a commissioned notary other than you . State of North Carolina, County of Sworn to (or affirmed) and subscribed before me this day of , 20 , By . (Name of Applicant) Signature of Notary Public: DO NOT NOTARIZE YOUR OWN SIGNATURE. My Commission Expires , 20 ( Official Seal or St amp) American LegalNet, Inc. www.FormsWorkFlow.com FORM MUST BE COMPLETE, LEGIBLE AND CORRECT OR APPLICATION MAY BE REJECTED OR DENIED PLEASE PRINT IN BLACK INK OR TYPE ASSISTANCE: The Notary Public Section is available for assistance from 8:00am to 5:00pm, Monday through Friday, with the exception of State H olidays. You may contact us by phone at (919) 814 - 5400 , by e - mail at notary@sosnc.gov , or by fax at (919) 807 - 2210. Visit our web site at www.sosnc.gov FEE: Make check or money order payable to NC Secretary of State in the amount of $50.00 . Fees are non - refundable (see N.C. General Statute 247 10B - 13). PLEASE DO NOT SEND CASH . will process your application wit hin 72 hours of receipt under normal circumstances . MAIL APPLICATION AND FEE TO: Notary Public Section Please allow two weeks to receive your oath notification letter . Department of the Secretary of State PO Box 29626 Raleigh, NC 27626 - 0626 APPLICATION INSTRUCTIONS - ALL INFORMATION REQUESTED IS REQUIRED BY N.C. G.S. 10B - 5, 10B - 6 & 10B - 7 1. Enter your full legal name. This name should match the name on your official identification. 2. Enter the name you wish to use for your notary p ublic commission. You may use one initial for the first or middle name or any combination of your full legal name but not two initials. No nicknames are permitted . This name should appear on your seal and must be used in signing all not arized documents. 3. Reappointment applicants must enter the n ame yo u used for your previous notary p ublic commission , including the expiration date and county of that commission. You must pla ce an imprint or stamp of your n otary seal in the space prov ided. Do not purchase a new seal until you have taken the new oath. 4. Enter your complete mailing and residence addresses. The mailing address can be a P. O. Box, however, if your residence address is different from your mailing address , enter yo ur residence address in the space allowed. The residence address must show a physical location with a street number and name . 5. Enter your business phone with area code including your extension , if applicable . Enter your home or cell phone with area code. E nter your fax number with area code . 6. Enter the last 4 digits of your Social Security number. Only the last four digits are required, however, providing the full Social Security number is recommended. 7. If you are not a U.S. citizen, attach a copy of an unexp ired U.S. government - issued document that permits you to reside and work in the United States, such as a permanent resident card (Form I - 551), an employment authorization card/document or a visa. Please note: you must continue to prove your federal permi ssion to reside and work in the U.S. if the document submitted expires before your notary commission. 8. Enter your complete home and business email address clearly and legibly. This should be updated as needed by e mail to our office at notary@sosnc.gov . 9. Enter the month, day and year of your birth. 10. Enter your county of residence. If you are a North Carolina resident, this is the county where you will be commissioned. 11. Enter your occupation (i.e., bank teller, paralega l, attorney, realtor, etc.). If you are unemployed, retired, a student, or self - employed, including city, state and zip code and the county of your principal employment. If you are not a North Carolina resident but your principal employment is in North Carolina, you must send proof of employmen t from your employer on company letterhead to be commissioned in the county of your employment. 12. If you cho se to take the reappointment exam after attending an in - person notary class, e nter the name of the college where you took the course, the name of your instruct or, the date that you completed the course and the number of hours. This section should be left blank if you took the online reappointment exam . 13. If you were commissioned on or before July 10, 1991, check yes. If not, check no and proceed to # 14. Enter the date of your initial appointment (if known). If you were commissioned on or before Jul y 10, 1991, indicate whether your commission has been continuous or not. If your commission has been continuous since July 10, 1991, indicate wh