Use "none or "N/A" if applicable. Incomplete and/or illegible applications may be returned. NON-REFUNDABLE FILING FEE: $10
*Full Name (first/middle/last): (Must match your State driver’s license or ID card)
*Driver’s License or Personal ID #
*State *County of Residence
*Please indicate any previous and/or alias names.
*Date of Birth
(mm/dd/yyyy)
*E-mail Address
*County of Business (Non-
Michigan Residents Only)
*Residential Address (Must match license or ID card – include PO boxes, lot and Apt #’s) *City *State *Zip Code
*Business Address *City *State *Zip Code
*Residence Telephone Number *Business Telephone Number
I have printed/typed my name as I wish to be commissioned. I understand that my name must appear exactly as I have printed/typed it
above for all notarizations for the duration of this commission
.
COMMISSION NAME:
Sign your name as
it will appear on all documents you notarize. I understand that
my signature must appear exactly as I have signed it above for all notarizations for
the duration of this commission.
For
County/Office Use Only
Attorney
County name:
*Are you are a resident of Michigan?
Yes No
YES NO
If yes, please explain below:
revoked suspended cancelled
OFFICE OF THE GREAT SEAL
MICHIGAN DEPARTMENT OF STATE
APPLICATION FOR NOTARY COMMISSION AND ATTORNEY REAPPOINTMENT
I hereby certify that I am 18 years of age or older; a resident of Michigan or maintain a principal place of business in Michigan; am a U.S. citizen or possess proof of
legal presence; am able to read and write in the English language; am not currently incarcerated in a correctional facility or have served time during the immediate past ten
years for a felony or misdemeanor offense in any state. I solemnly affirm, under the penalty of perjury, that the information provided in this application is true, complete, and
correct; that I have carefully read the notary laws of Michigan; 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. I understand that all information contained on this application is subject to disclosure under the Freedom of Information
Act, 1976 PA 442, MCL 15.231, et seq. I am enclosing the $10.00 non-refundable application processing fee. Checks made payable to State of Michigan. If I am a
licensed attorney, I certify that I am in good standing with the State Bar of Michigan.
*Licensed Attorney in Michigan, enter State Bar number or if
not licensed attorney write “N/A”
P-
County Seal
Date of oath and
bond:
Oath administered
by, and bond filed
with:
Form 98 Revised: 11/19
HISTORY
Within the last 10 years, have you been convicted of a felony or misdemeanor
(including any time served/fees paid)?
Have you ever had a notary commission in this or any other state?
Do you hold or have ever held a notary public commission in this or any other state:
If yes, indicate State:
Michigan or State of
ELECTRONIC AND REMOTE NOTARY
YES NO
Will you be performing electronic notarial acts?
If "Yes," identify the approved system you intend to use:
Will you be performing remote notarial acts?
If "Yes," identify the approved system you intend to use:
SIGNATURE:
