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STATE OF IDAHO

APPLICATION FOR APPOINTMENT AS NOTARY PUBLIC

PLEASE READ CAREFULLY AND COMPLETE ALL ITEMS.

FAILURE TO COMPLETE THE ENTIRE FORM WILL CAUSE REJECTION OF YOUR APPLICATION.

Mail to: Secretary of State, Notary, P.O. Box 83720, Boise, Idaho 83720-0080.

I, _________________________________ , hereby apply for appointment to a commission as

Notary Public for the State of Idaho. I make the following statements in support of the application:

(1) I am on this date at least eighteen (18) years of age.

(2) My gender is Male

Female

(check appropriate box).

(3) Former Name (if you have previously been commissioned in Idaho under another name): ________________________________

(4) Have you previously been commissioned in Idaho?: No

Yes

(5) I reside at: _______________________________________________________________________________________________

(Street Address)

__________________________________________________________________________________________________________

(City)

(Phone Number)

(6) If I am not a resident of Idaho, I am employed or doing business in Idaho at ___________________________________________

(Name of business)

__________________________________________________________________________________________________________

(Street Address)

(City)

(7) The mailing address to which the certificate should be sent (if different from (5)) is ____________________________________

__________________________________________________________________________________________________________

(Street Address or P. O. Box)

(City)

(8) Name, address and phone number of insurance agency which wrote the notary bond: __________________________________

(

Name of Agency)

__________________________________________________________________________________________________________

(Address)

(City)

(9) Name of bonding company and bond number: _________________________________________________________________

(Company)

(Bond Number)

10) I am able to read and write the English language.

(

(11) I have not been convicted of a serious crime nor removed from the office of Notary Public for official misconduct within the past

ten (10) years.

NOTE: If the applicant cannot truthfully make the statements in Items (1), (6), (10), and (11) above, he or she is ineligible to hold the

office of Notary Public, and should proceed no further with this application.

APPLICANT: Affix specimen of your (rubber stamp) seal here

(Seal can be purchased from office supply, stationery or stamp company)

(SEAL)

OATH OF OFFICE

I ________________________________________ , solemnly swear (or affirm) that the answers to all questions in this

application are true, complete and correct; that I have carefully read the notary laws of this State and I am familiar with their provi-

sions; that I will uphold the Constitution of the United States and the Constitution and laws of the State of Idaho; and I will faithfully

perform, to the best of my ability, the duties of the office of Notary Public.

Applicant signature

State of Idaho

)

County of ________________)

Subscribed and sworn (or affirmed) before me

this _____ day of _________________ , 19_____.

Notary Public signature

My commission expires on_____________, 19____.

DETACH AND RETURN THIS FORM ALONG WITH

THE $30.00 FILING FEE AND ORIGINAL NOTARY BOND.

Application For Appointment As Notary Public Form - Bureau Of Occupational Licenses, State Of Idaho

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