Colorado Notary Public Complaint Form

If you are a Notary Public who is registered in the State of Colorado and wish to renew your registration, you have to use this form. Complete and send the form along with any necessary filing fees.

Extracted Text for Proper Search

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.