Wyoming Notary Pubic Application Form

In the case of a resident’s desire to apply for becoming a public notary in the State of Wyoming, they are required to fill and submit the following form along with a $30 fee.Download

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Revised 	11/2012	 	
 	
Wyoming Notary Public Commission Application	 	
 	
Instructions	: Type or print clearly, filling in all blanks. Incomplete or illegible forms 	may 	be returned.	 	
 
1. Commission Name Style (type or 	print name to exactly match signature below)	 	
 
 	
2. County of Residence	 	
3. Gender	 	
	 Male	    	  	
	 Female	 	
 	
4. Last Name	 	5. First Name	 	6. Middle Name	 	
7. Residential Address (street/route)	 	
 
 	
8. City	 	9. Zip Code	 	10. Home Phone 	 	
11. Mailing Address (where notary	 information will be mailed)	 	
 
 	
12. City	 	13. Zip Code	 	
14. 	Name of Employer	 	
 	
15. Business Phone	 	
 
 	
16. Address of Employer	 	17. City	 	18. Zip Code	 	
 
 	
 
19. I am applying for:	 	
       		 A new commission; or	 	
       		 A renewal of my current commission. My current commission expiration date is: ___________________	 	
 
 
20	. Have you ever been a Wyoming notary?	 	
      		 Yes, under the name of ______________________________ in ________________________ County.	 	
      		 No.	 	
 
 
Certification:	 Please check all that apply, 	then 	sign	 (as shown in Item #1) and date the application.	 	
 	
I cert	ify that:	 	
1) 	 I am 18 years of age or	 older	. 	
2) 	 I am 	able to read 	and write the English language	. 	
3) 	 I am a	 resident of the 	State of Wyoming and of the	 County fo	r which I am making 	an 	application	. 	
4) 	 I have not been convicted of a felony	 or 	
5) 	 I have been convicted of a felony 	and my felony conviction has been	:  	
     		 Reversed or annulled	; 	
      		 Pardoned;	 or 	
      		 All rights 	have been 	restored 	pursuant to W.S. 7	-13	-105(a)	. 	
 
I further certify that I understand the duties and responsibilities imposed on notaries public under W yoming	 	
law and understand that breach of said responsibility may result in criminal penalties including imprisonment.	 	
 
 
_______________________________________	 	 	_____________________________	 	
Signature of 	Applicant 	(must match 	Item #1 above)	 	 	Date	 	
 Filing Fee: $30.00 (make checks payable t	o “Secretary of State”)	 	Submit	 application and filing fee to:	 	
 	
Notary Officer	 	
Secretary	 of State’s Office	 	
State Capitol Building, 	200 West 24	th Street	 	
Cheyenne, WY 82002	-0020	 	
Ph. 	307.777.7370