3f. Enter your residence address.
Note: This address is public information and will be provided
to the public upon request.
• Enter the address where you live.
• Do not enter a P.O. Box number.
4a. Enter any other name(s) you have used.
• This includes maiden name(s), prior married
name(s), name used prior to U.S. citizenship,
previous domestic partnership name(s), etc.
4.b If you have been held liable by a court in any civil proceeding
based on fraud or misrepresentation, failure to discharge the
duties of a notary public, or violation of state regulatory law
provide all details in the space provided.
• Your application may be rejected if lawsuits exist
and you do not provide the information.
• Attach additional page(s), if necessary.
4c. If applicable, enter the following information:
• Type of license;
• The name under which the license was issued;
• The date and reason of the revocation, denial,
suspension, restriction; and,
• The name and address of the licensing agency.
• Do not include information about the loss or
suspension of a driver’s license.
• Your application may be rejected if you do not
provide the information.
• Attach additional page(s), if necessary.
4d. If applicable, enter the following information:
• Enter the date and place where arrested or cited;
• Whether the conviction was for a misdemeanor or a
felony;
• The name of the court and court case number;
• The sentence imposed; and,
• The date you were released from probation, parole, or
incarceration.
Note: The only exceptions are traffic infractions, offenses
adjudicated in a juvenile court or under a youthful offender
law, and any incident that has been sealed under Welfare and
Institutions Code section 781 or Penal Code section 1203.45
(juvenile offenses).
• DUI’s must be disclosed.
• You must disclose any criminal charges pending in
any court of law.
• All convictions must be disclosed, regardless of
when or where occurring, even if you disclosed the
conviction on a previous application for a notary
public commission.
• Convictions that have been dismissed or expunged
pursuant to Penal Code sections 1203.4 or 1203.4a
also must be disclosed, regardless of the basis for
expungement.
• Attach additional page(s), if necessary.
• To determine whether you have a conviction that
may disqualify you for obtaining a notary public
commission, refer to the disciplinary guidelines
at www.sos.ca.gov/notary/disciplinary-guidelines
for
a list of the most common disqualifying convictions.
5. Enter the date signed.
Sign your name in the space provided.
Note: This application is signed under penalty of perjury and
must be signed.
• Include the month, day and year.
• You must be a legal resident of California or a
federal civil service employee, who is a United
States citizen being appointed and commissioned
on behalf of a military base or military installation
located within California.
Privacy Notification
Civil Code section 1798.17 requires notice be provided when collecting personal and confidential information from
individuals. Each individual has a right to review the personal information maintained by the Secretary of State relating to
that individual, unless access is exempted by law. Upon request, the Secretary of State will inform any individual regarding
the location of the individual's records and the category of persons who use the information contained in those records.
To obtain this information, contact Custodian of Records, Notary Public Section, P.O. Box 942877, Sacramento, California
94277-0001, Telephone (916) 653-3595. California Government Code section 8201.1 requires and authorizes collection of
the application information and fingerprints. The information is mandatory unless otherwise noted. If all, or any part of the
required information is not provided, processing of the application may be delayed until the required information has been
provided, or the application may be denied.
The principal purposes for collecting and using this information are: (1) To determine the fitness of persons to serve in the
capacity of notary public; (2) To determine if any disqualifying crimes have been committed by applicants; and (3) To enable
the Secretary of State to carry out the duties required by law. Information on this form filed by the applicant with the
Secretary of State, except for the name and address, is confidential and no record can be divulged by an employee having
access to the record to any person other than the applicant, his/her authorized representative, an employee or officer of the
federal government, the state government, or a local agency, as defined in California Government Code section 6252(b),
acting in his/her official capacity, or by order of court. The names and addresses listed in Items 1, 2, and 3 are public
information and will be provided to the public upon request.
SOS/NP-30 (REV 08/2016) 2016 California Secretary of State
www.sos.ca.gov/notary
