NOTARY PUBLIC CHANGE OF
ADDRESS OR EMPLOYER
The new address must be in the same county as you are presently registered as a notary. If you are a non-resident notary
public, the place of employment must be in the same county.
NAME __________________________________________ COMMISSION NUMBER __________________________________
COUNTY_________________________________________ DRIVER’S LICENSE# _____________________________________
NEW INFORMATION PREVIOUS INFORMATION
______________________________________________ ____________________________________________________
Residential Street Address Residential Street Address
______________________________________________ ____________________________________________________
City ZIP City ZIP
Phone Number (____) __________________________ Phone Number (____) ________________________________
Employer ____________________________________ Employer ____________________________________________
______________________________________________ ____________________________________________________
Street Address Street Address
______________________________________________ ____________________________________________________
City ZIP City ZIP
Phone Number (____) __________________________ Phone Number (____) ________________________________
Signature __________________________________________________ Date __________________________________________
To report a change of address or employer within the same county as you are registered, complete the above form. Please return to:
Secretary of State, Index Department, 111 E. Monroe St., Springfield, IL 62756. YOU MUST RESIDE IN the same county. If you are
the non-resident notary public, you MUST BE EMPLOYED in the same county.
If you have moved from the county in which you are registered, wish to change your listed name, or if you are a non-resident notary
public and your employment county has changed you must resign your commission and reapply.
If you have questions or need further clarification, please call 217-782-7017.
Printed by authority of the State of Illinois. January 2020 — 1 — I 243
