Colorado Notary Public Application Form
If you wish to become a Notary Public int he State of Colorado, you have to use this form. Complete and send the form in order to apply for this position.
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Notary Program 1700 Broadway, Suite 2 00 Denver, CO 80290 303 - 894 - 2200 www.sos.state.co.us Office Use Only APPLICATION FOR NOTARY PUBLIC COMMISSION P LEASE TYPE OR PRINT LEGIBLY . A LL SECTIONS MUS T BE COMPLETED . Print your legal name. This name will appear on your commission certificate and must be on your seal. Last Name: First Name: Middle/Init (opt): Suffix : Current or prior commission expiration date: Residence Address 1 : A physical addres s is required. Home P hone 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 P hone Number: Business Address 2 : City: Zip Code: 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 co mmissioned 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 Unite d 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 sta te law requires m e to provide proof that I am lawfully present in the United States prior to receipt of this public benefit. I further acknowle dge that making a false, fictitious, or fraudulent statement or representation in this sworn affidavit is punishable under the cr iminal 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 I am a Colorado Resident and 18 years of age or older. o I have never been convicted of a felony. o 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. o I am able to read and write the English language. o My commission as a notary has never b een 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 Commission Expiration Date Seal To receive your certificate, see instructions on page 2 . 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 APPLICATION , APPLICATION FEE, AND COPIES OF ID, TRAINING AND TESTING CERTIFICATES TO: COLORADO SECRETARY OF STATE 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.
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