Fillable ILLINOIS NOTARY APPLICATION PACKAGE.pdf

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ILLINOIS NOTARY APPLICATION PACKAGE.pdf

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NOTARIAL OATH State of Illinois, County of____________________________________
I do solemnly affirm, under the penalty of perjury, that the answers to all statements on this application are true, complete and correct; that I have carefully read
the notary law of the State of Illinois; and that if appointed and commissioned as a notary public,
I
will perform faithfully, to the best of my ability, all notarial acts in
accordance with the law. Further, my signature below authorizes the Office of the Secretary of State to
conduct a background verification to confirm the assertions
and information provided herein.
Printed Name as you
want Commissioned: _________________________________________________________________
Signature as you want
to be Commissioned: _________________________________________________________________
Notary Public Signature:_______________________________________________________________
Witnessed and Affirmed this ____________ day of _____________________, 20 _________________
AFFIX NOTARY SEAL HERE
NOTARY PUBLIC BOND
THIS BOND MUST BE WRITTEN BY A COMPANY QUALIFIED WITH THE ILLINOIS DEPARTMENT OF INSURANCE TO WRITE SURETY BONDS IN THE
STATE OF ILLINOIS. The Office of the Secretary of State does not recommend any particular bonding or insurance company.
Know all by these presents that we ________________________________________________________________________________as principal/applicant and
____________________________________________________________________ are held firmly bound unto the People of the State of Illinois, in the penal
sum of FIVE THOUSAND DOLLARS ($5,000), for the payment of which, well and truly to be made, we bind ourselves, our heirs, executors, administrators and
assigns jointly and severally, firmly by these presents.
THE CONDITION OF THE ABOVE OBLIGATION IS SUCH THAT, whereas, the above bound principal/applicant has applied for appointment by the Secretary of
State of the State of Illinois as a Notary Public for a four-year term.
Now, if said principal/applicant shall truly and faithfully perform and discharge the duties of said office of Notary Public, in all things according to law, then the
above obligation to be null and void, otherwise to remain in full force and virtue in law. The term of this bond is from the effective date of the principals’s/applicant’s
commission to the expiration date of the same.
x ______________________________________________________ x ______________________________________________________
Signature of Principal/Notary Public Applicant Signature of Authorized Representative of Surety Company
BOND NUMBER AFFIX CORPORATE SEAL HERE
Notary Public Application
Jesse White — Illinois Secretary of State
Enclose $10 fee payable to Secretary of State. Return completed form to: Secretary of State Index Department, 111 E. Monroe, Springfield, IL 62756.
Printed by authority of the State of Illinois. June 2015 — 1 — I 171.7
1. I am a U.S. citizen or an alien admitted for permanent residence.
2. I have been a resident of Illinois for at least 30 days.
3. I am age 18 or older.
4. I have never been convicted of a felony.
5. I am able to read and write the English language.
6. I have never had a notary public commission revoked.
Last Name: First Name: Middle Name or Initial:
Business Address (P.O. Box not acceptable):
Street: City: State: ZIP Code:
Name of Employer: Driver’s License or State Identification
Card Number (attach a photocopy):
Business Phone: Date of Birth: Applying for:
■
New Commission
■
Renewal of Commission
Current Expiration Date: _________ Commission Number: ____________
Email Address: Home Phone: County of Residence:
Current Home Address (P.O. Box not acceptable):
Street: City: State: ZIP Code:
Has your name, address or county changed since your last commission?
■
Yes
■
No
If, yes, give previous name, address and/or county: _______________________________________________________________________________________
Write N/A if you do not have a business phone
click to sign
signature
click to edit
FAST APPROVAL
NOTARIAL OATH
State of Illinois, County of____________________________________
I do solemnly affir
m, under the penalty of perjury, that t
h
e answers to all statem
en
ts on
th
i
s ap
plication are tru
e,
comple
te and correct; t
hat I have carefully rea
d
the notary law of t
he Sta
te
of Illinois; a
nd th
a
t if appointe
d
and commissione
d as a notary public, I will
p
erform faithfully, to th
e b
est of m
y ability, all notar
i
al acts in
a
c
cor
d
ance with the law. Further, my sign
ature below auth
orizes the
Office of the Sec
r
etary of State to conduct a background verification to confirm the assertions
and information
pr
ovi
de
d
herein.
P
r
inted Name as you
want Com
missioned: __________
_
___________
_________
__
___
______________
_
_________
__
___
Signa
ture a
s you
want
to be Commissio
ne
d: _________________
_____
_______________
____
__
__________________
____
Notary Public Signatu
re:__________
___
____
______
__
_____
__
_____
_______
_____
_____________
_
Witnessed and A
ffirm
ed this ___
__
_____
__ day o
f __
_____
___
__
________
_,
20 ___
__
___
_______
__
AFFIX NOTARY SEAL HERE
NOTARY PUBLIC BOND
THIS BOND MUST BE WRITTEN BY A COMPANY QUALIFIED WITH THE ILLINOIS DEPARTMENT OF INSURANCE TO WRITE SURETY BONDS IN THE
STATE OF ILLINOIS. The Office of the Secretary of State does not recommend any particular bonding or insurance company.
Know all by these presents that we ________________________________________________________________________________as principal/applicant and
____________________________________________________________________ are held firmly bound unto the People of the State of Illinois, in the penal
sum of FIVE THOUSAND DOLLARS ($5,000), for the payment of which, well and truly to be made, we bind ourselves, our heirs, executors, administrators and
assigns jointly and severally, firmly by these presents.
THE CONDITION OF THE ABOVE OBLIGATION IS SUCH THAT, whereas, the above bound principal/applicant has applied for appointment by the Secretary of
State of the State of Illinois as a Notary Public for a four-year term.
Now, if said principal/applicant shall truly and faithfully perform and discharge the duties of said office of Notary Public, in all things according to law, then the
above obligation to be null and void, otherwise to remain in full force and virtue in law. The term of this bond is from the effective date of the principals’s/applicant’s
commission to the expiration date of the same.
x ______________________________________________________ x ______________________________________________________
Signature of Principal/Notary Public Applicant Signature of Authorized Representative of Surety Company
BOND NUMBER AFFIX CORPORATE SEAL HERE
Jesse White — Illinois Secretary of State
Enclose $10 fee payable to Secretary of State. Return completed form to: Secretary of State Index Department, 111 E. Monroe, Springfield, IL 62756.
Printed by authority of the State of Illinois. March 2016 — 1 — I 171.8
1
. I am a U.S. ci
t
i
ze
n or an ali
e
n adm
i
tt
ed for permanent re
si
d
ence.
2
. I have b
een
a r
esi
de
nt of I
l
linois for at least 3
0 d
a
ys.
3. I am age 18 or
o
lder.
4. I have
never be
en con
v
icted o
f a felon
y.
5. I a
m able to read
and write the English language.
6. I have never had a
nota
ry public com
mission revoked.
Last Name: First Name: Middle Name or Initial:
Business Address (P.O. Box not acceptable):
Street: City: State: ZIP Code:
Name of Employer: Driver’s License or State Identification
Card Number (attach a photocopy):
Business Phone: Date of Birth: Applying for: New Commission Renewal of Commission
Current Expiration Date: _________ Commission Number: ____________
Email Address: Home Phone: County of Residence:
Current Home Address (P.O. Box not acceptable):
Street: City: State: ZIP Code:
Has your name, address or county changed since your last commission?
Yes No
If, yes, give previous name, address and/or county: _______________________________________________________________________________________
Instruction to complete the Illinois Notary Application
American Association of Notaries
®
• P.O. Box 630601, Houston, TX 77263
1-800-721-2663 • fax 1-800-721-2664 • www.illinoisnotary.com • sales@usnotaries.com
Bonds and errors and omissions insurance policies provided by this insurance agency, American Association of Notaries, Inc.,
are underwritten by Western Surety Company (established 1900).
American Association of Notaries is owned by Kal Tabbara, a licensed insurance agent in Illinois.
APP INST. 6-2018 -4
Return to: AAN
P.O. BOX 630601, Houston, Texas 77263
DOE
This section, the “Notarial
Oath”, must be completed
by a notary. Sign the
section in front of a notary
and return to AAN.
Do not leave any blank
spaces. Write N/A if the
field does not apply.
For example write N/A if
your are unemployed.
Attach a legible copy of
your driver's license or
state-issued ID.
(The state will reject applications
with an illegible copy of an ID)
These sections, will be
completed by the American
Association of Notaries (AAN).
First & last name must
match the name on your
driver's license. Use of
middle name is optional.
Your home address must
match the address listed
on your driver's license,
unless you have updated
it on the SOS website.
JOHN
Enter the county where
you reside, not where you
are employed.
This section will be completed by
the American Association of Notaries (AAN).
Your signature and your
name must read the same.
You can use “initial”
as your first name on this
section, but you cannot
abbreviate or use a
nickname. For example
“John Doe” can apply as
“J. Doe”and must
sign as “J. Doe”.
N/A
Bonding Agent Signature
J. DOE
J. Doe Signature
J. Doe Signature
N/A
N/A
N/A
N/A
SELF-EMPLOYED OR N/A
OPTIONAL
ORDER FORM
(
All States
)
American Association of Notaries
8811 Westheimer, Suite 207, Houston, TX 77063
Phone Number 1-800-721-2663 Fax 1-800-721-2664
By Phone:
1-800-721-2663
☎
✉
By Mail:
American Association of Notaries
PO Box 630601 Houston, TX 77263
ITEM #
QUANTITY
PRODUCT DESCRIPTION
(Include color choices for stamp ink and cases where applicable)
PRICE TOTAL
$
$
5.95
$
Office Hours: 9am – 5pm CST
Online:
www.usnotaries.com
Copyright © 2017 American Association of Notaries, Inc.
Guaranteed next-day shipment on most supplies.
AAN USOL 0117-1
All Rights Reserved.
Notary bonds and errors and omissions insurance policies provided by this insurance agency, American Association of Notaries, Inc.,
are underwritten by Western Surety Company, Universal Surety of America, or Surety Bonding Company of America, which
are subsidiaries of CNA Surety. American Association of Notaries is owned by Kal Tabbara, a licensed insurance agent.
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Sub-total _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
USPS Shipping
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
TOTAL
Type in any special instructions regarding shipping, stamp manufacturing, or other special needs
So that we may process your order promptly, please provide us with a copy
of your notary commission certificate. Use a work street address for
faster delivery and tracking service.
For fastest service, order online
or call your orders in. Most orders placed by noon CST during our normal
business hours will be shipped on the next business day.
Name as it appears on your commission certificate*
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
County Name (If Applicable) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Commission or Appointment # _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Commission expiration date (mm/dd/yyyy): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
*New applicants: Enter your name as it appears on your notary application. Leave exp. date & comm. no. blank.
Shipping Address
Company Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Address _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
City _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
State __________ Zip _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
☎
Daytime Phone Number ( ____ ) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Shipping Information: Your shipment contains valuable items. Please choose a work street address
where someone will be available to sign for your delivery.
Form of Payment
Mail To: PO BOX 630601, Houston, TX 77263
❏
Check enclosed payable to:
American Association of Notaries
Check No. ______________
❏
Please charge my credit card account:
❏ ❏ ❏ ❏
Expiration Date:
Customer Signature _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Billing Address
(Leave blank if same as shipping
)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Email Address__________________________________________________
AAN Membership/Account No.
(if available)
____________________________
Refund Policy: Requests for refunds on all incomplete orders must be in writing.
3 Easy
Ways
To Order:
Please add an
additional
$
6.00
for UPS Ground
delivery.
California notaries - Mail original “Certificate of Authorization” with your order.
Oregon notaries - Mail/Fax a copy of the “Certificate of Authorization” with your order.
AZ/GA/MO/MT/NV/OR/WA notaries - Mail/Fax a copy of your notary commission certificate.
North Dakota notaries - Mail/Fax ”Authorization to purchase notary public seal/stamp”form.
Utah notaries - Mail/Fax “Certificate of Authority of Notary Public”form.
Illinois Notary Bond
$30.00
Illinois Notary Errors & Omssions
Included
Notary Package
$12.95
State Filing Fee
$10.00
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Completed 16 July 2020

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