Mississippi Notary Public Change of Name Form

In the case of a registered Notary public in the State of Mississippi wanting to change his/her name, the following form has to be completed and submitted along with a 420 filing fee.

Extracted Text for Proper Search

MISSISSIPPI SECRETARY OF STATE 	
POST OFFICE BOX 1020 	
JACKSON, MISSISSIPPI 
392	
15-1020  	
 
APPLICATION FOR NOTARY PUBLIC CHANGE OF NAME  	
SOS FORM NP 005 April, 2007	  	 PAGE 1 of 1 Pages 	
 
This application must be typed or printed in ink.  This  form is designed to be completed and printed from your computer.  
You will not be able to save the form on your computer unl ess you have the appropriate software.   Return completed 
Application, together with the $20.00 fee to the S ecretary of State’s Office. 
 
The undersigned Notary, hereby, notifies the Secret ary of State of the following change nam
 e: 
 
_____________________________________________,  ___________________,  _____________ 
(Type or print name exactly as it appears on your Commiss ion)    (Commission expiration date)   (Notary ID Number) 
 
Please insert new name:___________________________________________________________ 
   	
(Type or print name exactly as you want it  to appears on your replacement commission) 
 	
The name change is as result of the following: 
Check one: 
      
  Marriage  
       Divorce 
       Court Order 
       Other 
 
Copies of appropriate documentation shoul d 
 be attached.  If you are also changing your address you may include any 
changes below: 
 
Street Address: __________________________________________ City: _____________, Mississippi Zip: __________ 
 
Telephone Number: ___________________________ 
 
County of Residence:  
 
Optional mailing address: ________ _________________________ City: _____________, Mi ssissippi Zip: ___________ 
 
Please include a business/employer address an d 
 telephone number as you would like it to appear in the Notary Directory.  If 
you do not include this information, yo u will be listed in the Notary Directory at  your mailing or residential address. 
 
Business Name: ______________________ ____ Job Title: ___________________ Telephone: ____________________ 
 
Mailing address: ______________ ________________________ C
 ity: ______________ State: ______ Zip: ___________  
 
Street address:  _______________________________________ City: ______________ State: ______ Zip: ___________  
 
 
This the _______ day of _______________, 20_____. 
 
 
 
__________________________________________ 
Signature of Notary