PAUL D. PATE
Application for
Secretary of
St
a
t
e Appointment as
State of
I
owa Notary Public
Read instructions before completing this application. Please type or print information clearly.
1. Applicant’s Name (as it will appear on the commission):
________________________________________________________________
_____________________________________________
First
Middle (Optional)
2. Applicant’s Home Contact Information:
_____
_______________________________________________________________________________________________________
House Number
Street Name
City
State
ZIP Code
_____________________________________________________
_
Home Phone Number
Home Email Address
3. Applicant’s Employer Contact Information:
__
Employer’s Name
_____________________________________________________________________________________________________________
Building Number
Street Name
City
State
ZIP Code
____________________________________________________
__
Applicant’s Work Phone Number
Applicant’s Work Email Address
4. Preferred Contact Method:
Designate preferred contact method. If no designation is made, home contact information will be used.
Home Contact Information
Employer Contact Information
Applicants filing by paper may find Iowa Code chapter 9B at this website:
http://www.legis.iowa.gov/docs/code/9B.pdf
Rev. 2-21
Last
10. Fee: $30.00.
Make check payable to SECRETARY OF STATE.
Applicant’s Signature
_______________________________________________________________
Date
_______________________________________
may not notarize any documents until I have received my notary commission from the Secretary of State.
that I have read
and understand the requirements of Iowa Code chapter
9B
and administrative rules in 721 chapter 43, and that I
the state of Iowa, I will faithfully and impartially discharge the duties of notary public according to the best of my ability, and
By submitting this filing
I hereby affirm that I will support the Constitution of the United States and the Constitution and laws of
9. Affirmation and Signature:
If “Yes”, list the language(s) in which applicant is fluent:
___________________________________________________________
Bilingual Notary Registry:
Does applicant wish to have name placed on a list of bilingual notaries:
Yes
No
8.
If “Yes”, applicant must also submit an Application for Approval to Perform Notarial Acts for Remotely Located Individuals.
pursuant to Iowa Code section 9B.14A:
Yes
No
Remote Notarizations - Effective July 1, 2020:
Does applicant intend to perform notarial acts for remotely located persons
7.
6.
Applicant is a resident of:
Iowa
or
resident of
__________
, a state bordering Iowa.
Qualifications:
Does applicant meet all the qualifications as stated in Iowa Code section
9B.21 (2)
:
Yes
No
5.
contact information from display on the Secretary of State’s Web site. Does applicant wish to exercise this option:
Yes
No
If applicant has provided business contact information different from home contact information, applicant may opt to shield home
If “Yes”, identify the tamper proof technology the applicant intends to use:
______________________________________________
Electronic records:
Will applicant be performing notarial acts with respect to electronic records:
Yes
No
NOTE: Do not combine this payment with any other types of payments you may be remitting to the Secretary of State.
PAUL D. PATE
Instructions for Application for
Secretary of State
Appointment as Notary Public
State of Iowa
Incomplete or incorrect applications will be returned. A notary commission for a resident is 3 years; nonresident is 1 year.
If any
information on this application changes during the duration of the commission, the Secretary of State must be notified within 30 days of the
change. Records of Iowa notaries are public records.
1. Applicant’s Name:
Documents must be notarized using the name that appears on the commission (e.g. if a middle initial is provided
on this form, it must be included during notarizations). A stamp or seal must be used when notarizing documents. The name on the
stamp or seal must be identical to the name that appears on the notary’s commission.
2. Applicant’s Home Contact Information:
Provide complete home address, phone number, and email address.
3. Applicant’s Employer Contact Information:
Provide name of applicant’s employer, employer’s complete address, applicant’s work
phone number, and work email address.
4. Preferred Contact Method: Check box to indicate applicant’s preferred contact method. If box is not checked, home address will be
designated. If applicant has provided business contact information different from home contact information, applicant may opt to shield
home contact information from display on the Secretary of State’s Web site. Check box to indicate if applicant would like to exercise this
option.
5. Qualifications:
Check boxes to indicate whether applicant meets all the requirements as stated in Iowa Code section
9B.21(2)
and
administrative rules in 721-chapter 43, and whether applicant is a resident of Iowa or resident of a state bordering Iowa with place of work
or business within the state of Iowa. If applicant is not a resident of Iowa, print the abbreviation for the bordering state in which the
applicant resides.
Applicants filing by paper may obtain a copy of Iowa Code chapter
9B
at the following Web site:
https://www.legis.iowa.gov/DOCS/ACO/IC/LINC/Chapter.9B.pdf
6. Electronic Records
Effective January 1, 2013:
Check box to indicate whether applicant will be performing notarial acts with
respect to electronic records. If “Yes”, identify the tamper proof technology the applicant intends to use.
8. Bilingual Notary Registry:
Check box to indicate whether applicant wishes to have name placed on a list of bilingual notaries. If
“Yes”, identify the languages in which applicant is fluent. This information is used by notaries and the public for referral
of clients who do
not speak English or have documents in languages other than English which require notarial services.
9. Affirmation and Signature:
Applicant must affirm the statement by signing the completed application.
10. Fee
:
$30.00
. Make check payable to SECRETARY OF STATE
DURATION OF COMMISSION: For an Iowa resident, a notary commission is effective for 3 years from the date of commission. For a
resident of a bordering state, a notary commission is effective for 1 year from the date of commission.
CHANGES:
If any information contained on this application changes during the term of your notary appointment, you are required to
notify the Secretary of State within 30 days.
NOTICE:
Iowa notary public records are available to the public.
Deliver completed application and $30.00 fee to:
SECRETARY OF STATE
Notary Division
Lucas Building, 1
st
Floor
Des Moines, IA 50319
Phone: (515)281-5204
Fax: (515) 242-5953
Website: sos.iowa.gov
Rev. 2-21
Notarial Acts for Remotely Located Individuals, which may be downloaded from:
https://sos.iowa.gov/business/FormsAndFees.h
.
tml#NC9B
located individuals. If “Yes”, applicant must also submit to the Secretary of State a completed Application for Approval to Perform
7. Remote Notarizations - Effective July 1, 2020:
Check box to indicate whether applicant intends to perform notarial acts for remotely
NOTE: Do not combine this payment with any other types of payments you may be remitting to the Secretary of State.