ATTORNEY APPLICATION FOR NOTARY PUBLIC COMMISSION NAME ___________________________________________________________________________________ Please print your name as you want it to appear on your notary commission PLEASE READ THE FOLLOWING INSTRUCTIONS BEFORE COMPLETING THE NOTARY PUBLIC APPLICATION The Notary Public examination is waived for attorneys. There is a $25.00 application fee which is payable to the Clerk of Courts. Once your completed notary application and application fee are received, your state application for the appointment of Notary Public will be mailed to you as soon as possible. An instructional guide for the completion of the notary application process will be mailed along with your state application. If you have any questions about this process, please call (740) 652-7433 or (614) 322-5275. Upon receiving your notary commission from the Commission Clerk for the Secretary of State, you must take the oath of office, and have your commission recorded in the Clerk of Courts’ Office, Room 212 in the Hall of Justice, Lancaster, before performing any notarial duties. You may purchase your stamp after you have had your commission recorded. 1. How long have you been a resident of the State of Ohio? _________________________________________ 2. Are you a resident of Fairfield County? ...................................................................................... YES NO 3. Have you been a resident of Fairfield County for at least 30 days? ............................................ YES NO 4. Are you 18 years of age or older?................................................................................................ YES NO 5. In what township, village or city do you reside? ________________________________________________ 6. Your mailing address (including zip code)_____________________________________________________ _______________________________________________________________________________________ Your physical address, if using a P.O. Box ____________________________________________________ _______________________________________________________________________________________ Home Phone #___________________________ 7. Circle the last grade of school completed by you. 1 Work Phone # _________________________________ 2 3 4 5 6 7 8 9 10 11 12 Did you graduate? YES NO School name and location __________________________________________________________________ College name and location _________________________________________________________________ How long?____________years ___________ months Did you graduate? .............................. YES NO Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com 8. Are you employed outside the home? YES NO If yes, list the name and address of your employer: _______________________________________________________________________________________ List your employment during the last five years: From-to Occupation Name of Employer Address _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 9. Have you ever in the past entered a plea of guilty to or been convicted of a felony? ................. YES NO 10. Have you ever been removed from any office for reasons involving moral turpitude or had a business or professional license revoked? ...................................................................................................... YES NO 11. Have you held a commission as a Notary Public in any other state or county? .......................... YES NO Name of state or county ___________________________________________________________________ Expiration date of commission ______________________________________________________________ 12. Have you ever been removed from the office of Notary Public? ................................................ YES NO If yes, for what reason_____________________________________________________________________ 13. What is your attorney registration number? ____________________________________________________ Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com PLEASE HAVE YOUR SIGNATURE NOTARIZED BEFORE RETURNING THIS FORM. State of Ohio, County of ____________________________ ___________________________, being first duly sworn, states that the statements contained in the foregoing Print Applicant’s Name application are true as he/she verily believes. ________________________________________________ Sign Your Name Sworn to me and subscribed in my presence this _______ day of ______________, 20___. ________________________________________________ Notary Public, State of Ohio APPLICATION FEE $25.00 RECEIVED THIS______DAY OF ______, 20___. BY________________________________________ PLEASE RETURN YOUR COMPLETED APPLICATION AND $25.00 CHECK OR MONEY ORDER MADE PAYABLE TO THE CLERK OF COURTS TO THE FOLLOWING: KELLY R. STARKEY HALL OF JUSTICE 224 EAST MAIN STREET, ROOM 102 LANCASTER, OHIO 43130 Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com