Application For Appointment As Virginia Notary Public

Commonwealth of Virginia Secretary of the Commonwealth Notary Division, PO Box 1795, Richmond, VA 232181795 Application for Appointment as a Virginia Notary Public Please print legibly. All questions must be answered or the application will be returned. Upon completion mail to: Secretary of the Commonwealth Notary Division, P.O. Box 1795, Richmond, Virginia 232181795 along with check or money order of $45.00 payable to the Treasurer of Virginia (Revised April 2010) Part 1: Gender: M F 1. Name: _________________________________________________________ If renewing, is this a name change? Yes No As your commission will read, must be the same as the name on your state issued ID. Previous name: _________________________ 2. New Applicant or Renewal Notary Registration Number (if renewing): _____________________ 3. Preferred Mailing Address (Please Check One): Home or Business 4. Home Address: City: State: Zip Code: 5. Present Employer (If Applicable): _____________________ or Unemployed Retired Student SelfEmployed 6. Business Address: City: State: Zip Code: 7. Home Telephone Number: 8. Work Telephone Number: 9. Cell Phone Number: ( ) ( ) ( 11. Date of Birth: ) 10. Email Address: _____/______/_________ mm dd yyyy 12. Circuit Court (City/County Court where you will take your oath): Please Check: Yes No Are you at least 18 years old? Are you able to read and write the English language? Have you ever been convicted of a felony? Failure to answer this correctly will subject you to criminal penalties and automatic revocation of your commission. Must provide: _____________________ _____________________ _____________________ Date(s) of Conviction(s) Court(s) Offense(s) If yes to previous question, have your Civil Rights been restored by a Governor following felony conviction(s)? Must provide documentation of your Restoration of Rights with this application. Are you currently serving as a Notary Public in Virginia? American LegalNet, Inc. www.FormsWorkFlow.com Part 2: Each statement must be initialed indicating that you understand the information provided. ____ A Virginia Notary Public must be familiar with and understand everything contained in "The Handbook for Virginia Notaries Public" throughout their term as a notary. If changes are made to notary laws, the updated handbook will be available by July 1. "The Handbook for Virginia Notaries Public" can be found on the website: www.commonwealth.virginia.gov/OfficialDocuments/Notary/notary.cfm. ____ A notary must always be completely satisfied with the identity of the person whose signature is being notarized. A notary is not obligated to notarize a person's signature without being sure that the person is who he or she claims to be. Always check identification and be satisfied that the identification is valid. Never accept the word of a third party as being sufficient for identification to justify notarizing person's signature. ____ A notary is not required to charge a fee for his or her services, but if a fee is charged, it cannot be more than $5.00 for each document notarized. ____ A notary cannot notarize birth, marriage, death certificates (originals or copies) or perform marriages. ____ A notary cannot perform any act that constitutes the practice of law. ____ The notary must notify the Secretary of the Commonwealth's Office of any changes to the information provided on their application during the course of their commission. ____ There are seven (7) items required for the notary to state on each document being notarized: 1. The name of the county or independent city in which the document is signed 2. The date the document is signed. 3. The notarial statement ­ what is being notarized 4. The notary's signature. 5. The date that the notary's commission expires 6. Notary registration number 7. Photographically reproducible notary seal/stamp ____ Every effort should be made to have complete notarization on the same page as the signature(s) being notarized. If notarization is on a separate page from signature(s), the notarial statement must include the name of each person whose signature is being notarized. ____ A Virginia notary's seal must contain the name of the notary exactly as it appears on the notary's commission, words "Notary Public" and "Commonwealth of Virginia." Stamps/seals must be ordered through an outside vendor. The Office of the Secretary of the Commonwealth does not sell or make notary stamps/seals. ____ By law, you must claim your commission within 60 days after it is issued. If you fail to do so you must submit a new application and a new fee to become a Notary. If you have not received your commission within four weeks call the Secretary of the Commonwealth's Office at (804)6922536 or by email to socmail@governor.viginia.gov.Sometimes notices are lost in the mail. Failure to receive a notice will not permit you to receive a commission after the 60day period has expired. Part 3: MUST be notarized by a Virginia Notary before submitting application I, _____________________________, solemnly swear or affirm under penalty of perjury that the information in this application is true, complete and correct that I understand the official duties and responsibilities of a notary public in the Commonwealth of Virginia, as described in the statutes and that I will perform to the best of my ability all notrial acts in accordance with the law. Signature of Applicant: _____________________________________________ (This signature must match the name on line 1 of this application and must be used in signing ALL notarized documents.) ***** TO BE COMPLETED BY VIRGINIA NOTARY BEFORE SUBMITTING ***** Commonwealth of Virginia City/County of ________________________________ Sworn and subscribed before me this _____ day of ___________________, 20_____ Signature of Notary Public: ______________________________________________ DO NOT NOTARIZE YOUR OWN SIGNATURE (Official Seal or Stamp) Notary Registration Number: _____________________________________________ My Commission Expires: _______________________________________, 20______ American LegalNet, Inc. www.FormsWorkFlow.com