State of North Carolina Department of the Secretary of State Visit our web site at Elaine F. Marshall, Secretary of State www.sosnc.gov NORTH CAROLINA NOTARY PUBLIC CHANGE OF NAME/ADDRESS/CONTACT INFORMATION PLEASE PRINT IN BLACK INK OR TYPE Check the block or blocks that apply: Change of Name Change of Address Change/Update Other Contact Information (e-mail, phone numbers, employer, etc.) Change of Name and Address with New County (DO NOT USE THIS FORM. If both name and county are being changed at the same time, use the Application for Reappointment Form) 1. N e w Full Le gal N ame: (First, Middle/Ma id en, Last 226 in c l u di n g ch a nges) Male Female 2. Current C o mmission N a m e : 3. Coun t y of C o mmission 4. Date of Birth: 5. F o rmer Mail i ng Add r ess: Ci t y : State: Zip: 6. Former Res i den c e Add r es s : Ci t y : State: Zip: 7. Social Se c u r i t y #: 8. E - Mail Add r ess: 9. N e w Commission Name: 10. N e w R e si d ence C o u n t y : 11. N e w M a il in g Address: Ci t y : State: Zip: 12. N e w R e si d ence A d dress: Ci t y : State: Zip: 13. Former B u siness/Em p l o yer Name: 14. Former B u siness/Em p l o yer A ddress: Ci t y : State: Zip: 15 . N e w B u sin e ss/Em p lo y er N a m e : 16 . N e w B u sin e ss/Em p lo y er Address: Ci t y : State: Zip: 17. F o rmer B u siness P h o n e # + ext: 18. F o rmer Home Pho n e #: 19. F o rmer F a x P h one #: ( ) ( ) ( ) 20. New Business Phone # + ext: 21. New Home Phone #: 22. New Fax Phone #: ( ) ( ) ( ) Signature of Applicant: Date (Sign with new commission name - Signature does not have to be notarized) American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR CHANGE OF NAME/ADDRESS/CONTACT INFORMATION FEE: No fee is required for filing the Change of Name/Address/Contact Information Form. MAIL FORM TO: Notary Public Section OR FAX FORM TO: (919) 807-2210 Department of the Secretary of State PO Box 29626 Raleigh, NC 27626-0626 EMAILTO: notary@sosnc.gov (The Department will accept a scanned image of the form that includes your hand-written signature.) NAME CHANGE GUIDELINES N.C. General Statute 247 10B-51(a) states: 223(a) Within 45 days after the legal change of a notary222s name, a notary shall send to the Secretary by fax, e-mail, or certified mail (return receipt requested), a signed notice of the change. The notice shall include both the notary222s former name and the notary222s new name. (b) A notary with a new name may continue to use the former name in performing notarial acts until all of the following steps have been completed: (1) The notary receives a confirmation of notary222s name change from the Secretary. (2) The notary obtains a new seal bearing the new name exactly as that name appears in the confirmation from the Secretary. (3) The notary appears before the Register of Deeds to which the commission was delivered within 45 days of the effective date of the change to be duly qualified by taking the general oath of office prescribed in G. S. 11- 11 and the oath prescribed for officers in G. S. 11-7 under the new name and to have the notary public record changed to reflect the new commissioned name. (c) Upon completion of the requirements in subsection (b) of this section, the notary shall use the new name.224 ADDRESS/CONTACT CHANGE GUIDELINES N.C. General Statute 247 10B-50 states: 223Within 45 days after the change of a notary222s residence, business, or any mailing address or telephone number, the notary shall send to the Secretary by fax, e-mail, or certified mail (return receipt requested), a signed notice of the change, giving both old and new addresses or telephone numbers.224 COUNTY CHANGE GUIDELINES N.C. General Statute 247 10B-52 states: 223(a) A notary who has moved to another county in North Carolina remains commissioned until the current commission expires, is not required to obtain a new seal, and may continue to notarize without changing his or her seal. (b) When a notary who has moved applies to be recommissioned, if the commission is granted, the Secretary shall issue a notice of recommissioning.224 *If the county changes due to the notary222s address change, the notary should continue to use the seal or stamp for the previous county of commission until the expiration of the current commission. Upon renewal of the notary222s commission the notary shall purchase a new seal containing the name of the new county of commission. ASSISTANCE: The Notary Public Section is available for assistance from 8:00 am to 5:00 pm, Monday through Friday, except on State Holidays. You may contact us at (919) 814-5400 or send an email to notary@sosnc.gov. PLEASE NOTE: Please allow approximately two weeks for processing. August 2009 NP-NAC American LegalNet, Inc. www.FormsWorkFlow.com