RENEWAL OF NOTARY PUBLIC COMMISSION NAME ___________________________________________________________________________________ Please print your name as you want it to appear on your commission 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. In what township, village or city do you reside? ________________________________________________ 5. Your mailing address (including zip code)_____________________________________________________ _______________________________________________________________________________________ Your physical address, if using a P.O. Box ____________________________________________________ _______________________________________________________________________________________ Home Phone #______________________________ Work Phone # ______________________________ 6. What is the expiration date of your present notary commission?____________________________________ 7. Is your present commission as a notary public of the State of Ohio recorded in Fairfield County? ...................................................................................................................................................... YES NO (IF NO, PLEASE ATTACH A COPY OF YOUR CURRENT RECORDED COMMISSION.) 8. Have you ever been removed from office of Notary Public? ...................................................... YES NO If yes, for what reason_____________________________________________________________________ 9. Have you ever in the past entered a plea of guilty to or been convicted of any violations of the laws of the United States or the State of Ohio other than motor vehicle violations and misdemeanors not affecting ones good moral character?.................................................................................................................. 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 Page 1 of 2 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 PLEASE RETURN THIS FORM WITH NO RENEWAL FEE AT THIS TIME TO: KELLY R. STARKEY HALL OF JUSTICE 224 EAST MAIN STREET, ROOM 102 LANCASTER, OHIO 43130 *YOUR STATE NOTARY APPLICATION WILL BE FORWARDED TO YOU ALONG WITH AN INSTRUCTIONAL SHEET ABOUT 4 - 6 WEEKS BEFORE YOUR COMMISSION EXPIRES. IF YOUR COMMISSION HAS ALREADY EXPIRED, YOUR STATE NOTARY APPLICATION WILL BE FORWARDED AS SOON AS POSSIBLE. *PLEASE CONTACT KELLY STARKEY AT (740) 652-7433 OR (614) 322-5275 IF YOU HAVE ANY QUESTIONS. Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com