MAKE IMPRINT OF SEAL HERE Submit to: Secretary of State, 500 East Capitol Ave, Pierre, SD 57501
State of South Dakota
Notary Public
Application, Oath & Bond
Filing Fee: $30.00
Type or print neatly - please read instructions.
TO THE SECRETARY OF STATE OF SOUTH DAKOTA: I hereby respectfully apply to
be commissioned as a Notary Public for the State of South Dakota.
NAME ___________________________________________________________________
(enter your name exactly as found on your seal imprint)
ADDRESS ___________________________________________________________________
CITY ___________________________________ STATE _______ ZIP_____________
COUNTY ___________________________________________________________________
Complete the following if you reside in an out-of-state county bordering South Dakota:
Employer/Business Name ________________________________________________________________
__________________
South Dakota Business Address: ________________________________________________________________
____________
Street Cit
State Zi
Have you ever been a SD Notary Public? __ Yes __ No If yes, when did/does your commission expire? ___________
Date of Birth ___________________________ Have you ever been convicted of a felony? ______________________
STATE OF SOUTH DAKOTA OATH
COUNTY OF ____________________
I, ________________________________________ , being first duly sworn, depose and state that the answers to the questions on
this application are true and complete to the best of my knowledge and that I am of legal age and meet the state residency
requirements of SDCL 18-1-1. I do solemnly swear that I will support the Constitution of the United States and the Constitution of the
State of South Dakota and that I will faithfully and impartially perform the duties of a NOTARY PUBLIC within and for the State of South
Dakota according to the law and to the best of my ability, so help me God.
Dated ______________________ _________________________________________________
(Applicant’s Signature)
BOND
Bond No. ______________________
(If a Personal Surety is being used, omit the following and complete the Personal Surety form on the backside)
We _________________________________________ , as principal, and __________________________________________are
(name of notary applicant) (name of surety company)
bound to the State of South Dakota in the penal sum of $5000.00 for payment of which we bind ourselves, our successors, or
representatives, executors, and administrators jointly and severally hereby. This obligation is conditioned upon appointment and
commission as a Notary Public of the above-named Principal by the Secretary of State and covers the official term of six (6) years from
the date of appointment. If the Principal performs well and faithfully all of the duties of the office of Notary Public according to the laws
of South Dakota, then the above obligation is to be null and void, otherwise, it is to remain in effect.
Dated this ______ day of ___________________________ _________________________________________________
(Applicant’s Signature)
_________________________________________________
(Surety’s Signature)
Approved by the South Dakota Attorney General File Date:__________________________________________
Commission date: ___________________________________
Receipt Number: ____________________________________
