This application must be signed under oath in the presence of a notary public and submitted to the County Clerk prior to the meeting
of the county commission at which it is to be considered. All applications, originals and renewals, must be submitted with the required
Twelve Dollar ($12.00) fee. If the County Clerk notarizes your application, you must include an additional Five Dollars ($5.00) with
your application fee. Once elected, you must then be commissioned by the Governor. If elected, you will be required to post a bond in
the amount of Ten Thousand Dollars ($10,000). The bond must be filed in the office of the County Clerk, who will accept the required
Two Dollar ($2.00) fee and administer the oath of office. You are not authorized to act as a notary public until you received your
commission from the Governor, filed your bond, and taken the oath of office. If you move your residence or your principal place of
business out of this county, you are required by law to notify the County Clerk of the change of address and be charged a fee of Seven
Dollars ($7.00).
Please answer ALL questions in PRINT NEW RENEWAL
Date of Application: ________________
Full Name: _________________________________________________________________________________
First Middle Last Suffix
Notary Name: _________________________________________________________________________________
Applicant's Printed Name Exactly As You Wish It To Appear On Notary Seal
Home Address: _________________________________________________________________________________
City State Zip
Employed By: _________________________________________________________________________________
Business Address: _________________________________________________________________________________
City State Zip
Home Phone: ____________________ Business Phone: ____________________ Fax: ____________________
Date of Birth: ____________________ Current Commission Expires: ____________________
Email Address: _________________________________________________________________________________
Please answer the following questions YES or NO
1. Have you ever been convicted of offering or giving a bribe, larceny, or any other offense declared infamous by law? YES/NO
2. If the answer to question 1 was YES, has your citizenship been restored? YES/NO
3. Is there an unpaid judgment against you for money received in an official capacity and due the United States, to Tennessee or
any Tennessee county, or are you a defaulter to the treasury? YES/NO
4. 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/NO
5. Have you ever been removed from office as a notary public of official misconduct?
6. Have you ever had a notarial commission revoked or suspended by this or any other state? YES/NO
7. 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/NO
8. Is there any other reason that you are legally disqualified from holding the office of notary public? YES/NO
9. Are you a United States citizen or legal permanent resident? YES/NO
Signature of Applicant _________________________________________________________________________________
State of Tennessee, KNOX County
Personally appeared before me, ______________________________, with whom I am personally acquainted, and who acknowledged
that he/she executed within instruments for the purpose there stated.
Witness my hand, at office, this ____ day of _______________, 20___
______________________________________ My Commission Expires: _________________________
Notary Public
For additional information and online services, visit us at www.knoxcounty.org/clerk
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