Please photocopy this form for your records before submitting to the Davidson County Clerk.
Incomplete
and/or un-notarized applications cannot be accepted.
APPLICATION FOR TENNESSEE NOTARY PUBLIC
DAVIDSON COUNTY, TENNESSEE
Co
unty Clerk’s Office
700 Second Avenue South, Suite 101
PO Box 196333, Nashville, TN 37219-6333
YOUR PERSONAL OR COMPANY CHECK MADE PAYABLE TO "DAVIDSON COUNTY CLERK" IN THE AMOUNT OF $12.00 MUST ACCOMPANY THIS
NOTARIZED APPLICATION. TO BE CONSIDERED, THE APPLICATION MUST BE ON FILE TWO WEEKS PRIOR TO THE MEETING OF THE METROPOLITAN
COUNCIL OF NASHVILLE AND DAVIDSON COUNTY. THE COUNCIL MEETS FOR THIS PURPOSE ON THE FIRST TUESDAY OF JANUARY, MARCH, MAY,
JULY, SEPTEMBER, AND NOVEMBER.
DATE OF APPLICATION ___________/__________/20___________
APPLICATION MUST BE PRINTED OR TYPED
Notary Name (please print)
(Name that you will use when notarizing documentsMust match signature below)
Residence
Address:
Home
City:
Home Zip
Code
Name of employer/company:
Business
Address:
Business
City:
Business Zip
Code:
Residence Phone: Business Phone:
Age: Gender:
Your e-mail
address Optional,
for DCC use only
PLEASE ANSWER THE FOLLOWING QUESTIONS BY CIRCLING YES OR NO
Are you a resident of Davidson County or do you have a principal place of business in Davidson County?
YES or NO
Have you ever been convicted of offering or giving a bribe, larceny, or any other offense declared infamous by law?
YES or NO
If the answer to the previous question was YES, has your citizenship been restored?
Is there an unpaid judgment against you for money received in an official capacity and due to the United States, to
Tennessee or any Tennessee county, or are you a defaulter to the treasury?
YES or NO
Are you a soldier, seaman, marine, or airman in the regular Army, Navy, or Air Force of the United States, a
member of the United States Congress, or a person holding any office of profit or trust under any foreign power,
other state or the United States?
YES or NO
Have you ever been removed from office as a notary public for official misconduct?
YES or NO
Have you ever had a notarial commission revoked or suspended by this or any other state?
YES or NO
Have you ever been found by a court of this state or any other state to have engaged in the
unauthorized practice of law?
YES or NO
Is there any other reason that you are legally disqualified from holding the office of a notary public?
YES or NO
I DO SWEAR AND AFFIRM UNDER PENALTIES OF PERJURY THAT THE STATEMENTS ABOVE ARE TRUE AND CORRECT.
Signature of Applicant_______________________________________________________________
(Must match "Notary Name" above)
APPLICANT'S SIGNATURE MUST BE NOTARIZED
State of Tennessee County of ________________________________
Sworn to and subscribed before me this ________ day of _____________________________ , 20
Notary’s Signature:__________________________________________________________________
Notary’s commission expires: ____________/____________/20________
PLEASE CIRCLE ONE:
NEW
or
RENEWAL
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