State of Wisconsin Permanent Commission Notary Public Application OFFICE USE ONLY COMMISSION DATE: Fee: $50.00 1. Is this your first Wisconsin commission? Yes No If 223No,224 indicate the most recent expiration date: 2. If the name on your last commission has changed and you have not notified us, list former name(s) here: 3 . Current Full Name: Fir st Middle Last Suffix 4 . Mailing Address In Care of: (Business Name, if applicable) Address Line City State Zip 5 . Email Address (For contact and/or sending commission certificate) 6 . Date of Birth (MM/DD/YYYY) 7 . Phone Number (Be st number to contact) 8. State Bar Number 9. Have you ever been convicted of a felony in Wisconsin and/or in the United States? Yes No If yes, please submit documentation of the conviction(s) and current status of the conviction(s). 10. To the Department of Financial Institutions: I hereby apply for a permanent appointment as a Wisconsin Notary Public. I certify that I am a United States resident and licensed to practice law in Wisconsin, that my license has never been surrendered, suspended, or revoked for any reason, and that all the information I have provided is true. Applicant Signature: Submit: Completed Permanent application Certificate of Good Standing from the WI Supreme Court $50.00 payable to: WI Dept of Financial Institutions (unless previously submitted electronically) 11. Place a clear impression of seal/stamp sample here. If impression is not clear, apply sample to plain paper and include with this application. 12. Sign your name exactly as it appears on your seal/stamp 13. Print your name exactly as it appears on your seal/stamp First Middle Last Suffix Email or mail completed application to: Mailing Address: Contact us: DFINotary@wisconsin.gov Notary Records Section Call: 608 - 266 - 8915 WI Dept of Financial Institutions Fax: 608-264-7965 PO Box 7847 Madison WI 53707-7847 You are hereby informed that the information you provide on the application may be considered a public record available for public inspection. DFI/NOT/103 (R08/17) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com State of Wisconsin Department of Financial Institutions Notary Records Permanent Commission Notary Public Instructi ons This document can be made available in alternate formats upon request to qualifying individuals with disabilities. You may NOT perform notarial acts until you are notified by the Department of Financial Institutions that the commission has been issued. General Requirements Permanent notary commissions, under s. 137.01(2), 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. If your license to practice law in Wisconsin has been suspended or revoked, and has been reinstated, you may apply for a four year notary commission only. 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. Wisconsin Statutes require that you provide written notice of any change of address to the Wisconsin Department of Financial Institutions within 10 days of the change. Grounds for revocation of your commission may include: providing false information on this application, 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. You must acquire: An official rubber stamp (preferred) or an engraved official seal that only contains 223State of Wisconsin,224 223Notary Public,224 and your printed name that must include your full current last name. Initials or a shortened first name may be used. No title such as 223Atty.224 or 223Esq.224 may appear before or after your name. A Certificate of Good Standing from the Clerk of the Wisconsin Supreme Court, PO Box 1688, Madison, WI 53701-1688. A fee of $3.00 (payable to 223Wisconsin Supreme Court224) must accompany the written request. Include your name, attorney number and approximate date of admission. The certificate of good standing must be dated within two months of submission of your notary application. Instructions for completing the Permanent Notary Public Application 1. Indicate the expiration date of your most recent Wisconsin notary commission unless this is your first commission. 2. If you had a previous notary commission in Wisconsin and your name has changed, enter your former name(s) 3. Enter your current full legal name (first, middle, last and suffix (Jr, Sr, if applicable)). 4. Enter your complete mailing address. Use 223In Care Of224 only if the mailing address is a business address. 5. Please enter your email address to receive communication regarding your notary application and commission certificate. You may wish to add 223DFINotary@wisconsin.gov224 to your contacts to prevent the email from being sent to a spam folder. 6. Enter your date of birth. 7. Enter your phone number with the area code. If you have an extension, enter that after your phone number. 8. Enter your State Bar Number. 9. Answer 223Yes224 or 223No.224 Attach an explanation if you answered 223Yes.224 10. Read the statement and apply your original signature if you agree with the statement. 11. Affix a clear impression of your notary seal/stamp in the space provided. (If the impression/stamp leaves an unclear mark, affix additional samples on a separate white sheet of paper and include the paper with your application.) 12. Sign with your official notary signature using the exact spelling as shown on your notary seal/stamp. 13. Enter your name exactly as signed (and as the name appears on the seal/stamp.) Submit the following: Completed application Certificate of Good Standing from the WI Supreme Court $50.00 payable to: WI Dept of Financial Institutions (unless you paid electronically) Email or mail completed application to: Mailing Address: Contact us: DFINotary@wisconsin.go v Notary Records Section Call: 608 - 266 - 8915 WI Dept of Financial Institutions Fax: 608-264-7965 PO Box 7847 Madison WI 53707-7847 DFI/NOT/103 (R08/17) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com