NORTH CAROLINA DEPARTMENT OF THE SECRETARY OF STATE PO BOX 29626, RALEIGH, NC 27626-0626 VOICE 919.814-2500 - FAX 919.807-2210 NOTARY@SOSNC.COM WWW.SOSNC.COM CERTIFICATE OF MORAL CHARACTER FOR: Applicant for Notary Public Section A 1- I am aware of the charges/convictions against this Notary applicant. Yes No 2- Will the charges/convictions against this applicant affect his/her ability to act as a Notary. Yes No 3- How long and well have you known the applicant? (This form is to be completed by someone other than a family member that has known the applicant for at least 2 years. Please include the nature of your relationship.) 4- What opportunities have you had for forming an opinion of this applicant222s character? 5- Are you personally acquainted with the applicant222s associates? If so, what is their reputation in the community? 6- What is the applicant222s reputation for honesty? Integrity? Trustworthiness? Character? Section B Please indicate to the best of your knowledge whether or not the applicant has ever been accused of a violation of trust such as: 7- Dropped, suspended, asked to resign or subjected to other discipline from an educational institution Yes No 8- Discharged or asked to resign from employment Yes No 9- Addicted to the use of drugs (illegal or legal) or intoxicating liquors Yes No 10- Regularly treated for any form of or mental disability Yes No If the answer to any of the above is yes, please explain in detail on a separate page. Section C Please indicate your honest opinion: 11- Would you recommend this applicant for a position of trust and confidence? Yes No 12- Does this applicant possess the high standards of moral character you would expect from a notary? Yes No If the answer to either of these two questions is no, please explain in detail on a separate page. --------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that the information given in the foregoing answers is, where given from personal knowledge, correct; and where given from information received from others, has been obtained from sources which I believe to be reliable and was not secured from the applicant or members of the applicant222s family. I personally recommend to become a Notary Public. (printed name of Applicant) Name of Character Witness: Signature of Character Witness: Address: Occupation: Telephone: --------------------------------------------------------------------------------------------------------------------------------------------------------- State of North Carolina County: Signed and sworn to before me this the day of , by . (printed name of Character Witness) (Official Signature of Notary Public) (seal) My Commission Expires: , 20. CERTIFICATE OF MORAL CHARACTER ADDENDUM American LegalNet, Inc. www.FormsWorkFlow.com