Notary ID#: FEE: $52.00**** The undersigned agrees to conform with the Notary Laws as set forth in West Virginia Code 24739-4 ****as it pertains to performing notarial acts in West Virginia.***IMPORTANT*** READ AND FOLLOW THE ATTACHED INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS APPLICATION TO AVOID IT BEING REJECTED AND SENT BACK TO YOU FOR CORRECTION. (Please type or print in ink.) Section 1: APPLICANT'S INFORMATION a . Print your exact name as you will enter it when performing a notarial act. i.If you have ever been a WV Notary, enter the expiration date of your last notary commission: (mm/dd/yyyy) ii.If you have ever been commissioned under a different name, please enter it here: b. Please indicate your gender:Male Femalec. Mailing address in West Virginia youAddress: will use on your notary seal: 225 If this is a business address, include the company name. 225 Government notaries226 Use agency name City/State/Zip: and address. County: d. E-mail address (required) where correspondence e. Phone Number (daytime):Phone Number (evening): f. Answer 223YES224 or 223NO224 to the following questions by checking the appropriate box: Y N1. Are you at least 18 years of age?2. Are you a citizen or permanent legal resident of the United States?3. Are you a West Virginia resident or do you work for a place of employment in West Virginia?4. Are you able to read and write English?5. Do you have a high school diploma or its equivalent?6. 7. Do you plan on performing electronic notarial acts? If "Yes," you must comply with West Virginia Code 24739-4-19 and attach to this application the E-Notarization Authorization (Form N-2 ). See instructions for definition of 223electronic224 notarial acts per West Virginia Code 24739-4-2(2) .****************************** APPLICATION CONTINUED ON PAGE 2 ******************************* WEST VIRGINIA APPLICATION FOR APPOINTMENT AS A NOTARY PUBLICWest Virginia Secretary of State Licensing Division Tel: (304)558-8000 Fax: (304)558-8381 Website: www.wvsos.gov Email: notary@wvsos.gov Form N-1 Rev. 6/2018FILE ONE ORIGINAL (Two if you want a filed stamped copy returned to you.) For Office Use Onlymay be received:Could you be or have you ever been disqualified to receive commission under WV Code 24739-4-21 or 24739-4-23 ? NO BOND REQUIRED Effective June 3, 2018 American LegalNet, Inc. www.FormsWorkFlow.com West Virginia Application for Appointment as a Notary Public Page 2 8. Are you a state or local government employee applying to become a notary public only for and in behalf of your government office? If you answer 223YES,224 give your position title and the name of the office in the lines indicated below. To have the fee waived, a letter from the head of your office certifying that the application is made for the purpose of the office must be attached. Federal employees are not eligible. (Your title) (Name of state or local government office)You must complete the required section below per West Virginia Code 24739-4-20(c) . NY I, {printed name of applicant}, solemnly swear or affirm, under penalty of perjury, that the answers to all questions in this application are true, complete, and correct; that I have carefully read the notary public law of West Virginia; and, if appointed and commissioned as a notary public, I will perform faithfully, to the best of my ability all notarial acts in accordance with the law. APPLICANT SIGN HEREX **** SIGNATURE REQUIRED **** Sign your name on the line above exactly as you entered it in Section 1.Important Note: This form is a public document. Please do NOT provide any personal identifiable information on this form such as social security number, bank account numbers, credit card numbers, tax identification or driver222s license numbers. certifying that the application is made for the purpose of the office in order to have the fee waived.) 2.$52.00 Filing Fee (* State/Local government employees must include theletter from the head of your office 1.The completed, original Application for Appointment as a Notary Public (Form N-1), this application. Only forms issued by the West Virginia Secretary of State222s Office will be accepted. An application missing any part of the above listed items cannot be accepted and will be immediately returned for corrections. Expedite Service - Order Request form for additional fee. 3. Deliver all the above to one of the processing centers listed in the attached Filing Submission Instructions. DATEAdditional fee applies if requesting expedite service. Refer to the attached Customer IMPORTANT - BEFORE YOU SEND, CHECK THE BOXES BELOW INDICATING YOU HAVE INCLUDED THE FOLLOWING ITEMS: Payment Options - Check or Money Order: Make payable to West Virginia Secretary of State Credit Card: You must complete and include the attached e-Payment Authorization form. E-Notarization - If you plan to perform electronic notarial acts (e-notarization), you must attach to this application the completed E-Notarization Authorization application (Form N-2 ). You must select a valid technology to electronically notarize documents. The technology you choose must meet the requirements set forth in West Virginia 153 CSR 45 .There is no additional fee to file the E-Notarization Authorization application. Learn more about E-Notarization . Section 2: APPLICANT'S AFFIRMATION American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTONS FOR FILING THE APPLICATION FOR APPOINTMENT AS A NOTARY PUBLIC*** IMPORTANT *** You must READ AND UNDERSTAND THE NOTARY LAWS as set forth in24739-4 of the West Virginia Code. Also, read the NOTARY HANDBOOK BEFORE applying to become a notary public in West Virginia. Failure to provide a proper notary acknowledgement on documents is a violation of the notary code and you may have your notary commission conditioned, suspended, or revoked. CAREFULLY FOLLOW THE STEPS OUTLINED BELOW. I. Complete both sections of this application. If you omit any part or do not sign the application, the form will be returned to you as incomplete.II. Send the completed application and Customer Order Request form (include e-Payment Authorization if paying by credit card) to:III. YOU ARE NOT AUTHORIZED TO ACT AS A NOTARY UNTIL ALL STEPS ARE COMPLETED AND YOU HAVE RECEIVED A CERTIFICATE OF APPOINTMENT. If your application is approved, you will receive a letter containing further instructions. When you receive the letter, read it carefully and immediately follow the instructions as outlined in the letter. If you have questions or need further assistance, please call the Notary division at (304) 558-8000 or toll free at (866) 767-8683. Section 1: APPLICANT'S INFORMATION (Please type or print in ink.) a. Print your exact name as you will enter it when performing a notarial act. You do not need to include your middle name or middle initial unless that is how you want it to appear on your notary stamp. i. If you have ever been a WV Notary, enter the expiration date of your last notary commission in the space provided. ii.If you have ever been commissioned under a different name, please enter it in the space provided. b. Indicate your gender ("Male" or "Female") by checking the appropriate box. c. Enter the mailing address in West Virginia you will use on your notary seal. 225 If this is a business address, include the company name in the address. 225 Government notaries -- use government agency name in the address. State and local government employees may be commissioned as government notaries to act for and in behalf of their respective state and local government office. A government notary may not operate privately. Specific information relating to government notaries may be found in West Virginia Code 24739-4-31.d. Enter a valid e-mail address (required) where business correspondence may be received. Example: yourname@domain.come. Enter your phone number with area code for both daytime and evening where you may be reached. f. Answer 223YES224 or 223NO224 to questions 1 through 8 by checking the appropriate box next to each question. Section 2: APPLICANT'S AFFIRMATION#7. E-Notartization - Definition of 223electronic224 notarial acts per West Virginia Code 24739-4-2(2) : "'Electronic' mea