MAIL APPLICATION, APPLICATION FEE, AND COPIES OF ID, TRAINING AND TESTING CERTIFICATES TO:
COLORADO SECRETARY OF STATE Notary Program 1700 Broadway, Suite 200 Denver, CO 80290 303-894-2200 www.sos.state.co.us
Office Use Only
APPLICATION FOR NOTARY PUBLIC COMMISSION PLEASE TYPE OR PRINT LEGIBLY. ALL SECTIONS MUST BE COMPLETED. Last Name:
Print your legal name. This name will appear on your commission certificate and must be on your seal. Middle/Init (opt): Suffix: Current or prior commission First Name: expiration date:
Residence Address 1: A physical address is required.
Home Phone Number:
Address 2:
City:
Zip Code:
PO Box: (If applicable)
PO Box City:
PO Box Zip Code:
Email Address: Business Address 1: If employed, this is required. If not employed, write “None”.
Business Phone Number:
Business Address 2:
Zip Code:
City:
AFFIRMATION I, solemnly affirm, under the penalty of perjury in the second degree, as defined in section 18-8-503, Colorado Revised Statutes, that I have carefully read the notary law of this state, and, if appointed and commissioned as a notary public, I will faithfully perform, to the best of my ability, all notarial acts in conformance with the law. Check only one:
I am a United States Citizen, OR I am a Permanent Resident of the United States, OR I am lawfully present in the United States pursuant to Federal law.
I understand that this sworn statement is required by law because I have applied for a public benefit. I understand that state law requires me to provide proof that I am lawfully present in the United States prior to receipt of this public benefit. I further acknowledge that making a false, fictitious, or fraudulent statement or representation in this sworn affidavit is punishable under the criminal laws of Colorado as perjury in the second degree under Colorado Revised Statute 18-8-503 and it shall constitute a separate criminal offense each time a public benefit is fraudulently received. o o o o o
I am a Colorado Resident and 18 years of age or older. I have never been convicted of a felony. I have not been convicted of a misdemeanor involving dishonesty as defined in C.R.S. 12-55-102(1.4) during the last five years. I am able to read and write the English language. My commission as a notary has never been revoked.
(Applicant must sign and date in front of a notary public.)
_________________________________________________________ Official Signature of Applicant
_________________ Date
Subscribed and affirmed before me this ________ day of ________________ , 20_____ , in the county of ____________________ , State of Colorado. ______________________________________________ Signature of Notary Public or other Qualified Officer
To receive your certificate, see instructions on page 2.
______________________ Commission Expiration Date
Seal
Applications paid by check for new and renewing notaries take longer to process. For faster processing upon receipt of your application documents in our office, and a lower fee, please file electronically at the Secretary of State’s website.
Mail form with correct payment to: Colorado Secretary of State 1700 Broadway Ste 200 Denver, CO 80290 Make checks payable to: Colorado Secretary of State Include a separate check for each form submitted for filing. If a document is rejected, this will allow us to return the check at the time of rejection (if applicable). The document can be corrected and resubmitted with the returned check. Checks must be written for the exact amount or the document may be rejected and returned.
Do not include this page with your filing.
