Form: INSTRUCTIONS FOR WISCONSIN ATTORNEYS’ PERMANENT NOTARY PUBLIC APPLICATION Permanent notary commissions are available only to residents of the United States, who are also licensed to practice law in Wisconsin, and whose license has never been suspended or revoked for any reason. If you are not an attorney, you are not eligible to apply for a permanent commission – you may apply for a four-year notary commission only. Do not use this form – use the four-year application and bond forms. General Requirements: In order to become a Notary Public under s. 137.01(2), Wisconsin Statutes, you must be a resident of the United States and be licensed to practice law in this state. (Note that under current law, persons, convicted in state or federal court of a felony, or persons convicted of a misdemeanor involving a violation of the public trust, may not be commissioned as Notaries Public for the State of Wisconsin unless they have been pardoned of the conviction.) Additionally, if your license to practice law in Wisconsin has been suspended or revoked, and has been reinstate, you may apply for a four year notary commission only. You must buy an engraved official seal or official rubber stamp, obtain a “Certificate of Good Standing” from the Wisconsin Supreme Court, and submit this application., $50.00 filing fee, and the original certificate of good standing to the Wisconsin Department of Financial Institutions. YOU MAY NOT PERFORM NOTARIAL ACTS UNTIL NOTIFIED BY THIS OFFICE THAT YOUR COMMISSION HAS BEEN ISSUED. Seal and Signature Requirements: To complete #1 of this application, you will need to buy a notary seal or rubber stamp. The Wisconsin Dept. of Financial Institutions does not provide seals/stamps. For suppliers, check the yellow pages in the telephone book under “office supplies,” “rubber stamp suppliers,” or “seals”. The seal or stamp may be of any size, but may state only the words “Notary Public,” “State of Wisconsin,” and your printed name. Initials or a shortened first name may be used. Current last name must be in full. No title, such as “Atty.” or “Esq.”, should appear before or after your name; no extra words, such as “My commission is permanent” may appear on the seal/stamp. When ordering a seal/stamp, keep in mind that when performing a notarial act, you must always sign your name exactly as set forth on your seal/stamp. An application submitted with an unclear seal/stamp impression, with additional non-notarial seals affixed, cannot be accepted for filing and will be returned. When you receive your seal or stamp, practice using it before attempting to affix it on this application, and if necessary, affix the impression on a separate piece of paper and attach it to your application. Certificate of Good Standing: Request a Certificate of Good Standing form the Wisconsin Supreme Court, PO Box 1688 Madison, WI 53701-1688. A fee of $3.00 (payable to “Wisconsin Supreme Court”) must accompany the written request. The certificate must be no more than two months old when submitted to the Dept. of Financial Institutions. Completing Your Application: (The numbers below correspond to the questions on the application.) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Affix a clear impression of your notary sea/stamp in the space provided. (if unclear, affix additional samples on a separate sheet of plain paper and enclose with your application.) Sign your official notarial signature using the exact spelling shown on your notary seal/stamp. Print or type your name exactly as signed. Print or type your complete mailing address. Answer “yes” or “no” and provide expiration date if needed. Print or type your full name. Print or type your Star Bar Number. Print or type your date of birth. Answer “yes” or “no.” Attach an explanation if you answered “yes.” Answer “yes” or “no.” Attach an explanation if you answered “yes.” Answer “yes” or “no.” Attach an explanation if you answered “yes.” Answer “yes” or “no.” Attach an explanation if you answered “yes.” Answer “yes” or “no.” Attach an explanation if you answered “yes.” Sign your name after you have completed the application to certify that you are a resident of the United States who is licensed to practice law in Wisconsin, and that all information you have set forth on the application is true. Submit the completed application with the $50.00 filing fee and an original certificate of good standing to the Dept. of Financial Institutions, P O Box 7847, Madison WI 53707-7847. Make your check payable to “Dept. of Financial Institutions”. Commissions are issued every Wednesday. Remember, you may not perform notarial acts until notified by this office that your commission has been issued. A commission certificate will be sent to the mailing address you indicate in #4 on the application. Notice: You are hereby informed that the information you provide on the application may be considered a public record available for public inspection. Wisconsin Statutes require that you provide written notice of any change of address to the Dept. within 10 days of the change. Grounds for revocation of your commission may include: providing false information on this application, submitting an application fee which is unredeemable due to insufficient funds or conviction for certain crimes while holding a commission, or supreme court notice (to DFI) of the surrender, suspension or revocation of your license to practice law in Wisconsin. American LegalNet, Inc. www.FormsWorkFlow.com WISCONSIN ATTORNEY’S Notary Public Application PERMANENT COMMISSION –$50.00 OFFICE USE ONLY Commission issued: _____________________ Put clear seal/stamp sample here. If not totally clear, try again on a plain paper & clip to form. NOTE: APPLICANTS MUST BE ATTORNEYS LICENSED IN WISCONSIN Complete all sections or application cannot be accepted for filing. See Instructions. 6. Current Full Name: ________________________________________________________________________ First Middle Last State Bar Number: _________________________ Birth Date: ______________________________ 9. Has your law license ever been suspended or revoked for disciplinary reasons?  Yes or  No. If yes, attach a letter of explanation. 10. Did you ever surrender your law license, or was it ever suspended or revoked for administrative reasons, such as failure to comply with CLE reporting and attendance requirements. Failure to pay Stare Bar dues, failure to provide attorney trust account information, etc.?  Yes or  No. If yes, attach a letter of explanation. 11. Did you ever have a notary commission or other state awarded license suspended or revoked in Wisconsin or any other state?  Yes or  No. If yes, attach a letter of explanation. 12. Do you have a pending arrest, or have you ever been convicted of a violation of Wisconsin, U.S., or any other state’s or country’s laws?  Yes or  No. If yes, attach a letter of explanation. _________________________________ 13. Do you have any unpaid judgments or other uncompleted court orders, including probation?  Yes or  No. If yes, attach a letter of explanation. Mailing Address: (print or type) C/O ______________________________ Note: Under current law, persons convicted in state or federal court of a felony, or persons convicted of a misdemeanor involving a violation of the public trust, may not be commissioned as Notaries Public for the State of Wisconsin unless they have been pardoned of the conviction. Street ____________________________ 2. 7. 8. 1. 14. Signature sample exactly as on seal/stamp: _________________________________ 3. 4. Print name as signed: _________________________________ City _____________________________ To the Department of Financial Institutions: I hereby apply for permanent appointment as a Wisconsin Notary Public. I certify that I am a resident of the United States and licensed to practice law in Wisconsin, that my law license has never been surrendered, suspended or revoked for any reason, and that all of the information I have provided is true.. Signature: _______________________________________________________________________________________ State ________________Zip _________ 5. Submit completed application and certificate of good standing together with the $50.00 fee to: Is this your first WI Commission: Yes or No. If no, indicate expiration date : Dept. of Financial Institutions/Notary Records P O Box 7847 Madison WI 53707-7847 Date: _________________________________ Make check payable to Dept. of Financial Institutions. If you have questions, please call 608-267-6811 American LegalNet, Inc. www.FormsWorkFlow.com