Wyoming Notary Public Commission Application Instructions: Type or print clearly, filling in all blanks. Incomplete or illegible forms may be returned. 1. Commission Name Style (type or print name to exactly match signature below) 2. County of Residence 3. Gender  Male  Female 6. Middle Name 4. Last Name 7. Residential Address (street/route) 5. First Name 8. City 11. Mailing Address (where notary information will be mailed) 9. Zip Code 10. Home Phone 12. City 13. Zip Code 14. Name of Employer 15. Business Phone 16. Address of Employer 17. City 18. Zip Code 19. I am applying for:  A new commission; or  A renewal of my current commission. My current commission expiration date is: ___________________ 20. Have you ever been a Wyoming notary?  Yes, under the name of ______________________________ in ________________________ County.  No. Certification: Please check all that apply, then sign (as shown in Item #1) and date the application. I certify that: 1)  I am 18 years of age or older. 2)  I am able to read and write the English language. 3)  I am a resident of the State of Wyoming and of the County for which I am making an application. 4)  I have not been convicted of a felony or 5)  I have been convicted of a felony and my felony conviction has been:  Reversed or annulled;  Pardoned; or  All rights have been restored pursuant to W.S. 7-13-105(a). I further certify that I understand the duties and responsibilities imposed on notaries public under Wyoming law and understand that breach of said responsibility may result in criminal penalties including imprisonment. _______________________________________ Signature of Applicant (must match Item #1 above) _____________________________ Date Filing Fee: $30.00 (make checks payable to “Secretary of State”) Submit application and filing fee to: Notary Officer Secretary of State’s Office State Capitol Building, 200 West 24th Street Cheyenne, WY 82002-0020 Ph. 307.777.5335 Revised 10/2010 American LegalNet, Inc. www.FormsWorkFlow.com