Notary Public Change Of Status
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1Please complete the form, print, sign and mail to the Kansas Secretary of State with
Print
Reset
the filing fee. Selecting 'Print' will print the form and 'Reset' will clear the entire form.
KANSAS SECRETARY OF STATE
NC
Notary Public Change of Status
Instructions:
Complete questions 1-2 and the applicable section(s) below. Sign
and submit to the Secretary of State’s office. Contact the notary clerk if you have any
Contact Information
questions.
Kansas Secretary of State
Memorial Hall, 1st Floor
120 S.W. 10th Avenue
1. Name: _________________________________________________
Topeka, KS 66612-1594
Print name under which your appointment is currently listed.
(785) 296-2239
notary@sos.ks.gov
2. Bond Number: __________________________________
Number listed in the upper right-hand corner of
appointment certificate.
CHANGE OF NAME
New name:
_______________________________________________________________
(print or type)
New signature: ______________________________________________________________________
CHANGE OF SEAL
Give an impression
of your new seal in
this space:
CHANGE OF ADDRESS
Residential address: _________________________________________ _____________________ ______ __________
Street address
City
State
Zip
Business address:
_________________________________________ _____________________ ______ __________
State
Zip
Street address
City
Daytime telephone number: (______) ________________
Secondary telephone number: (______) ________________
I declare under penalty of perjury pursuant to the laws of the state of Kansas that the foregoing is true and correct.
Date: __________________________
Month, Day, Year
_______________________________________
_______________________________________
Printed name of signer
Signature
Rev. 3/23/10 jdr
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