Submit this form No fee 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 LEGAL 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 only if you are not ordering a new seal or providing a new signature. I wish to continue using the name under which I was originally commissioned. This is an official name change notification only. Notary Commission No: Commission Expiration: Notary Commission Name: (Name on your official seal) New legal name: Reason for change: 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: ( ( ) Current Commission Signature ) Effective date of change Please continue to use your current seal and sign your “old” name until your commission expires. 518 (New. 10/08) American LegalNet, Inc. www.FormsWorkflow.com