Submit this form No fee 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 JOURNAL LOCATION PLEASE TYPE OR WRITE LEGIBLY IN BLACK INK. READ INSTRUCTIONS BEFORE FILLING OUT FORM. If you have decided to let your commission expire, please complete this form. Oregon Administrative Rules require that you file the location of your journal storage for the seven-year period following expiration of your commission if you are not re-applying. That information is required to be filed with the Secretary of State within 30 days following the date of your commission expiration. For your convenience, we have provided this form to complete that requirement. In addition, you are required to destroy your official notary seal and/or official seal embosser. Notary Commission No: Commission Expiration: Notary Commission Name: Termination (i.e., resignation, expiration). Explain: Your Mailing Address (Include city, state, zip): Daytime phone number and extension: Home phone number: Message phone number: ( ( ( ) Journal storage address: ) ) Describe exact location of journal at storage address: THE OFFICIAL NOTARY SEAL NEEDS TO BE DESTROYED UPON EXPIRATION OF YOUR COMMISSION Signature Date If you have chosen to leave your journal with your employer, you must have a letter of retention agreement with that employer. Employer - ORS 194.154 and 194.335 160-100-360 A notary public who has entered into an agreement with his/her employer relating to the employer’s retention and disposal of the notary public’s notarial records following termination of employment pursuant to ORS 194.152(3) shall retain a written copy of the agreement, which may be examined by the Secretary of State upon request. The agreement shall contain at least the following information: (1) Date agreement was entered into; (2) Names of parties to agreement; (3) Terms of agreement, including retention of records by the employer for a period not less than seven years after termination of the notary’s commission; (4) Signatures of all parties to agreement. 505 (Rev. 09/06) American LegalNet, Inc. www.FormsWorkflow.com