Submit this form and fee $5.00 This Space For Office Use Only STATE OF OREGON Corporation Division – Notary 255 Capitol Street NE, Suite 151 Salem, OR 97310-1327 503-986-2593 FAX 503-986-2300 FilingInOregon.com/notary This Space For Office Use Only NOTARY PUBLIC COMMISSION NAME CHANGE PLEASE TYPE OR PRINT LEGIBLY IN BLACK OR DARK BLUE INK. ALL SECTIONS MUST BE COMPLETED. FILING THIS NAME CHANGE DOES NOT CHANGE YOUR COMMISSION EXPIRATION DATE Use this form if you wish to obtain a seal with your new name, and you wish to sign your new signature. Please reissue my Commission in my new legal name. Notary Commission No: Commission Expiration: Current Notary Commission Name: New legal name: Commission name to be changed to: Reason for change: Print legal name as it appears on your official identification. Current Address where notary materials should be mailed Current Business Name & Address: Current Resident Street Address (If different from mailing address above): Daytime Phone Number & Extension: Home Phone Number: ( ( ) Applicant’s Legal Signature (New Official Signature) ) Effective date of change You will be issued an updated Commission and a Certificate of Authorization to obtain an Official Seal under your new name. The completed certificate must be returned to the Secretary of State within 10 days after receipt of your new official seal from the vendor. 519 (New. 10/08) American LegalNet, Inc. www.FormsWorkflow.com