Kansas Notary Public Amendment Form

In the case of Notary Public wanting to modify his/her registered information at the Secretary of State’s office in the State of Kansas, the following form has to be completed and submitted.

Extracted Text for Proper Search

Residential address: _________________________________________  ________\
_____________  ______  __________    
Business address:  	 _________________________________________  _____________________  ______\
  __________    	
 
Daytime telephone number: (______) ________________           Secondar\
y telephone number: (______) ________________	
NC	Notary Public Change of Status
KANSAS SECRETARY OF STATE	
CHANGE OF NAME
New name: 	
(print or type) 	_______________________________________________________________	
 
New signature: _________________________________________________________\
_____________	
CHANGE OF SEAL
Give an impression 
of your new seal in 
this space:	
CHANGE  OF ADDRESS	
                             Street address            State              Zip
                                   City	
Instructions:  	Complete questions 1-2 and the applicable section(s) below.  Sign 
and submit to the Secretary of State’s office. Contact the notary clerk if you have any 
questions.
1.  Name:  _________________________________________________	
    Print name under which your appointment is currently listed.	
2.  Bond Number:  __________________________________	
      Number listed in the upper right-hand corner of 
      appointment certificate.	
 	I declare under penalty of perjury pursuant to the laws of the state of \
Kansas that the foregoing is true and correct.	
 	Date:  __________________________	
Month, Day, Year	
 	_______________________________________	 	_______________________________________	
 	   Signature	  	  Printed name of signer
Rev. 3/23/10 jdr	
Contact Information
Kansas Secretary of State Memorial Hall, 1st Floor 120 S.W. 10th Avenue
Topeka, KS 66612-1594 (785) 296-2239
[email protected] www.sos.ks.gov	
                             Street address            State              Zip
                                   City