State of Rhode Island and Providence Plantations Department of State - Business Services Division Instructions for Filing Application for Reappointment to Office of Notary Public Section 42-30-5 of the General Laws of Rhode Island, 1956, as amended This legal document should be typed. All illegible documents will be REJECTED. How to complete the form: The Rhode Island Office of Notary Public is available to Rhode Island residents, non-residents who conduct business on a regular basis within the State of Rhode Island, and Attorneys and Certified Public Accountants in good standing. All applicants are required to know the powers and duties of the Rhode Island Office of Notary Public. Educational materials are available at www.sos.ri.gov/divisions/NotaryPublic. Please review RIGL 42-30; Executive Order 09-08; Standards of Conduct and all accompanying rules and regulations prior to remitting your application. Oath of Office All applicants must appear before a Rhode Island Notary Public to complete the Oath of Office. The Notary will administer your oath of office. 1. The applicant completes the "Applicant" section of the certificate. 2. The Notary Public administering the oath completes the "Notary" section of the certificate. How to pay the filing fee: The filing fee for a four year commission is $80, payable either in person via cash, credit card, or check at the Business Services Division, or by mail to the Business Services Division via check made payable to the R.I. Department of State. Application Information 1. List the applicant's commission ID number. The ID number can be found by looking up your name in the Notary Database. 2. List your full legal name. 3. List your current address. 4. Check one box only: � If applying as a non-resident you must provide your occupation, name of employer and business address in the State of Rhode Island. � If applying as an Attorney, you must provide your Bar Number and a copy of your most recent membership card to the RI Bar Association. Do not provide a copy of your Judicial Identification Card. � If applying as a Certified Public Accountant, you must provide your Certificate# and a copy of your most recent membership card issued by the RI Board of Accountancy. 5. Sign the application using the signature you will affix to documents as a Rhode Island Notary Public. Type or Print your name as it will appear on your notary commission. (This name should match the signature you will affix to documents as a Rhode Island Notary Public.) How to confirm your filing: You will receive your Notary Comission in the mail in approximately three weeks. Your term will expire four years from the date of commission. A renewal notice will be mailed to you at the address listed, so please contact this office if you change your address. How to maintain your commission: Visit our website at www.sos.ri.gov/divisions-notarypublic for information on keeping your commission active and up to date. American LegalNet, Inc. www.FormsWorkFlow.com Notary Renewal - Revised: 09/2016 State of Rhode Island and Providence Plantations Department of State - Business Services Division Application for Reappointment to Office of Notary Public Filing Fee: $80.00 (Four year commission) By remitting this application in accordance with the provisions of RIGL 42-30, the undersigned applicant is attesting that he/she is at least eighteen years of age; can speak, read and write the English language and has gained sufficient knowledge of the powers and duties pertaining to the Rhode Island Office of Notary Public. STAMP FOR SECRETARY OF STATE USE ONLY APPLICATION INFORMATION I attest I am a United States Citizen or Permanent Legal Resident of the United States. 1. Commission ID Number 2. Full Legal Name (First, Middle, Last) 3. Address City/Town State Zip Code Phone Number 4. If applicable, check one box only: I am not a Rhode Island Resident, but conduct business on a regular basis within Rhode Island. Name of Employer: Address: City/Town: State: Zip Code: Occupation: I am an Attorney, in good standing, applying as a member of the Rhode Island Bar Association. I have enclosed a copy of my most recent membership card. (RI Bar Association #:_____________) I am a Certified Public Accountant (CPA), in good standing, applying as a certified Rhode Island licensee. I have enclosed a copy of my most recent membership card. (CPA #: _____________) I certify this is my signature and it is the signature I will use when signing documents as a Rhode Island Notary Public. Type or Print Name of Applicant as it will appear on the Notary Commission Date Signature of Applicant APPLICANT SIGN HERE MAIL TO: Division of Business Services 148 W. River Street, Providence, Rhode Island 02904-2615 Phone: (401) 222-3040 Website: www.sos.ri.gov STAMP FOR SECRETARY OF STATE USE ONLY American LegalNet, Inc. www.FormsWorkFlow.com Notary Renewal - Revised: 09/2016 State of Rhode Island and Providence Plantations Department of State - Business Services Division Application for Reappointment to Office of Notary Public Oath of Office Each applicant MUST take the Oath of Office before a Rhode Island Notary. OATH OF OFFICE Applicant I, _________________________________, do solemnly swear (or: affirm) that I will support, protect and defend the constitution of the United States, and the constitution and laws of the State of Rhode Island, and I will discharge the duties of my office of Notary Public for the State of Rhode Island with fidelity so help me God. [or: this affirmation I make and give under the penalty of perjury.] Type or Print Name of Applicant Date Signature of Applicant APPLICANT SIGN HERE County: Notary State: RHODE ISLAND On this ______ day of________________, 20_____, before me personally appeared ___________________________ (name of applicant) being personally known to me or proved through satisfactory evidence of identification to be the person who signed the preceding or attached document in my presence, and to whom I administered the Notary Public Oath of Office. Type or Print Name of Notary Public Signature of Notary Public NOTARY SIGN HERE Commission Expiration Date Commission ID # American LegalNet, Inc. www.FormsWorkFlow.com If you have any questions, please call us at (401) 222-3040, Monday through Friday, between 8:30 a.m. and 4:30 p.m., or email corporations@sos.ri.gov. Notary Renewal - Revised: 09/2016