Arizona Notary Public Address Change Form

Should a notary public decide to change her/his address or name, s/he must inform the State of the change by filing this form. Accomplished version of the form must be mailed to this address: _______________.Download

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O f f i c e   F o r m   S O S B S a d d r e s s n a m e                                              N o t i c e   o f   A d d r e s s / N a m e   C h a n g e  
 	
 
State of Arizona	 	
Notary Public Address/Name Change Form	 	 Mail to: Arizona Secretary of State Ken Bennett 
Attention: Business Services, Notary Department 
1700 W. Washington Street, 7th Fl., Phoenix, AZ 850 07-2888 
(602) 542-6187  (800) 458-5842 (within Arizona)  
Website: www.azsos.gov	
     Fax: 602-542-4366	 	
 	
Address change	:  File an address change 
within 30 days of the change (A.R.S. §  
41-323). Failure to notify of a mailing or 
residential address change within 30 
days may result in a $25 civil penalty.  Name change	: File a name change within 30 days of the 
change of surname (A.R.S. § 41-327). Failure to not ify the 
secretary of state of this change of surname is evi dence 
of the notary's failure to fully and faithfully dis charge the 
duties of a notary. The commission may be revoked.	
 	
DO NOT 	WRITE IN 	THIS 	SPACE	 
              	
FOR 	OFFICE 	USE ONLY 	– REV. 08/05/11	 	 	
NOTICE OF 	ADDRESS	/N	AME 	CHANGE	 	 	About this form  
Use this form to notify the Secretary of State of a n address or name 
change to your Arizona Notary Public Commission. 
   Submission Requirements: 
This form must be submitted by means providing a re ceipt. Submit 
your completed form by fax, certified mail or in pe rson to the 
Secretary of State’s Phoenix or Tucson offices (see  addresses). 	
 Send completed form by CERTIFIED MAIL to the addres s above, 	 	or return in person to: 
PHOENIX - State Capitol  
Executive Tower 
1700 W. Washington Street 
First Floor, Room 103  TUCSON - Arizona State 
Complex Building 
400 W. Congress 
Second Floor, Room 252 
Open Monday through Friday, 8 a.m. to 5 p.m. except  state holidays. 	
 1. Notary Information	 	
 NOTARY COMMISSION NUMBER OR SOCIAL SECURITY NUMBER     
 LAST NAME (As shown on notary certificate)    FIRST NAME (As shown on notary certificate)  	 MIDDLE (If used) 	
 2. Address Change ~ Check appropriate box and updat e address 
a.  NEW MAILING ADDRESS  	 DATE OF NEW MAILING ADDRESS   FORMER PHONE NUMBER   N EW PHONE NUMBER 	
 FORMER MAILING ADDRESS   CITY   STATE   ZIP CODE 
 NEW MAILING ADDRESS  CITY   STATE   ZIP CODE 
b.   NEW HOME ADDRESS  	 DATE OF NEW HOME ADDRESS   FORMER PHONE NUMBER   NEW  PHONE NUMBER 	
 FORMER HOME (Physical) ADDRESS 
    CITY   STATE   ZIP CODE 
 NEW HOME
 (Physical) ADDRESS 
    CITY   STATE  ZIP CODE 
c. 
 NEW BUSINESS ADDRESS 	  DATE OF NEW BUSINESS ADDRESS   FORMER PHONE NUMBER   NEW PHONE NUMBER 	
 FORMER BUSINESS NAME   NEW BUSINESS NAME 
 FORMER BUSINESS ADDRESS (This address is a public record)     CITY   STATE   ZIP CODE 
 NEW BUSINESS ADDRESS (This address is a public record)      CITY   STATE   ZIP CODE 
 3. Name Change ~ Check appropriate boxes, fill in  surname, attach name change documentation. 
NAME CHANGE & NOTARY COMMISSION:  
If you ONLY want to use your new name as a notary 
public you must apply for a new commission. Refer to 
the application for Notary Public Commission and 
instruction form for applicable requirements and fe es.	
 	
  A.R.S. § 41-327: A notary public who has a change  of surname may continue to use the 
official seal and commission in the notary public's  prior name until that commission expires. 
The notary shall sign the changed surname on the li ne that is designated for the notary 
public's signature on the notarial certificate. Imm ediately below that signature, the notary 
public shall sign the name under which the notary w as commissioned. 	
REASON FOR NAME CHANGE	  	 NEW SURNAME 	
 
 Marriage	    Divorce	 	   Other	 	  IF OTHER, SPECIFY 	
 4. Notary Signature 
  SIGNATURE (Required)   DATE