Notary Commission Application

The data which you furnish on this form will be used by the Office of the Secretary of State and the Department of Commerce to

assess your qualifications for a commission. The information on this form, including your name and designated

address, is public pursuant to Minnesota Statutes, Chapter 13.

A. Application (Mark the box that applies to you)

New Appointment

Reappointment Address Change

Name Change

Fee: $120

(Commission has expired)

Renewal

Fee: $120

Can renew online at

notary.sos.state.mn.us

No Fee

Can update online at

notary.sos.state.mn.us

No Fee

(Attach documentation)

B. Commission Number (Required for reappointment, renewal, address change and name change)

Current Commission Number

C. Applicant Information — List your name the way it appears on your driver’s license, tax

returns and legal documents

First Name Middle Name or Initial Last Name

Residential Street Address (PO Box must include Rural Route or Street Address)

City S

tate

ZIP

Date of Birth (applicant must be 18 years old)

mo/day/yr

Telephone w/ area code

County of Residence ( Non-residents must list a Minnesota County he or she will be filing in upon receiving their notary commission from the Office of the

Secretary of State)

D. Business Name and Address — This information is optional and applies if notarization is a function of your job

Business Name

Address (Business location where the notary conducts business, PO Box must include rural route or street address) Telephone w / area code

City State ZIP

Choose the address you would like displayed alongside your name on the Office of the Minnesota Secretary of

State website. Failure to indicate a preference will result in an incomplete application.

Residential

Business

E. Former Residential Address (Required if filing an address change. PO Box must include rural route or street address)

F. Former Name (Required if filing a name change. Must attach legal document showing name change, e.g. copy of

marriage certificate, divorce decree, driver’s license, court order, etc.)

OFFICE OF THE MINNESOTA

SECRETARY OF STATE

For your convenience, this form has been designed to be

completed online. You must have Acrobat Reader 7.0 or above to

use this new feature. Once your form is completed, be sure to

select "Print" at the bottom of the screen to capture your data

entry for printing. After printing, sign and send applicable fees as

required.Note: Selecting "Reset" will clear all data entry from this

page. To print a blank form, go to File->Print.

ALL APPLICANTS MUST ANSWER QUESTIONS 1-4

NOTE: You do not need to answer YES below if the answer is due to an event(s) that occurred PRIOR to

your last

approved application to be a notary public and after having submitted the supporting documentation. However, if

new issues leading to a YES response have occurred since then, you must file this Notary Application form,

including YES answer(s) and provide the supporting documentation that is requested.

If the answer to any question is YES, you must attach an explanation including the specific dates, charges,

resolution, attach copies of legal documentation and complete the background check form. All items including

these answered questions, Notary Application, Background Check Form and supporting documentation when

applicable, must be mailed together to the Office of the Secretary of State.

1. Have you ever been the subject of any inquiry or investigation by any

state agency?

If yes, submit a written statement explaining the circumstances of incident and copies of Department

letters or order which demonstrate the final resolution of the matter.

YES NO

2. Have you or has any occupational license held by you been censured, suspended, revoked, canceled,

terminated or otherwise been the subject to any type of administrative action in any state including

Minnesota?

If yes, submit:

A. a written statement explaining in detail the type of license and the circumstances of each incident.

B. a copy of the notice of hearing or other document that states the charges and allegations.

C. a copy of the official document which demonstrates the resolution of the charges or any final judgment.

YES NO

3. Have you ever been charged with, or convicted of, or been indicted for, or entered a plea to, any

criminal offense (felony, gross misdemeanor or misdemeanor), in any State or Federal Court? You may

exclude the following misdemeanor convictions or pending misdemeanor charges: traffic citations, DUI,

DWI or driving without a license, reckless driving, or driving with a suspended or revoked license. You may

also exclude juvenile adjudications (offenses where you were adjudicated delinquent in a juvenile court).

If yes, submit:

A. a written statement explaining in detail the circumstances of incident, copies of police report and

charging documents. If no longer on file, submit a statement as such from the charging authority on their

letterhead.

B. copies of the sentencing and disposition documents. Register of Actions is not acceptable unless it

contains an official court stamp confirming that it is the only document available. If currently on probation,

attach letter from probation officer stating compliance with terms of probation. If not currently on

probation, state you are not on probation.

YES NO

4. Have you been a defendant in any lawsuit involving claims of fraud, misrepresentation,

conversion, mismanagement of funds, breach of fiduciary duty or breach of contract?

If yes, submit:

A. a written statement explaining in detail the circumstances of incident.

B. a copy of the Petition, Complaint or other document that commenced the lawsuit or arbitration, or

mediation proceeding.

C. a copy of the official documents, which demonstrate the resolution of the charges or any final judgement.

YES NO

APPOINTMENT OF THE SECRETARY OF STATE AS AGENT FOR SERVICE OF PROCESS. KNOW ALL PEOPLE BY THESE

PRESENT: That in compliance of the Laws of the State of Minnesota, I, the undersigned applicant, if a nonresident, do

hereby appoint the Secretary of State of the State of Minnesota, his/her successor or successors, as my true and

lawful agent upon whom may be served all legal process in any action or proceeding in which I may be a party arising

out of or re-lating to the transactions of the commission, and do hereby expressly consent and agree that service

upon such agent shall be as valid and binding as if due and personal process has been made upon me and that such

appointment shall be irrevocable.

I certify that the statements in this application and attachments are true and complete and that this document has not

been altered or changed in any manner from the form adopted by the Office of the Secretary of State.

OATH: I swear or affirm that I will support the constitution of the United States and of this state to

discharge faithfully the duties of my office to the best of my judgment and ability.

Signature of Notary Applicant

Date

Reset

INSTRUCTIONS

1. To obtain a Notary commission, submit this completed application with the application fee to the Office of the Secretary of State.

2. The notary commission fee is $120.00. The fee is non-refundable and must be paid by check or money order made payable to

the OFFICE OF THE SECRETARY OF STATE Do not send cash through the mail.

3. Applicant must be at least 18 years of age. Applicant must be either a Minnesota resident, or a resident of a county in IA, ND,

SD, or WI and list the Minnesota County he or she will be filing in upon receiving their commission. Non-resident notary applicants

must designate the Secretary of State as their agent for service of process.

4. Upon receipt of your commission, you must register it with the county. Your resident county name and telephone number will

be listed in the instructions portion of your commission certificate. Please contact the county for directions to the appropriate location

to register your commission. Note: there is a $20.00 fee charged at the county level.

5. Upon receipt of your commission, you must purchase a notary stamp. When you notarize a document, your notary stamp

must match the name on your commission certificate however you may sign documents using your normal signature if different then

what is listed on your commission certificate.

6. Notary commissions expire on January 31 of the fifth year following the year of issue. Applications for renewal may be

submitted 6 months prior to the expiration date of your current commission or a reappointment can be made any time after the

expiration of your commission. Upon receipt of your new commission, re-register your commission with the county where you are

commissioned, and purchase a new notary stamp. Your resident county name and telephone number will be printed in the

instructions portion of your new commission certificate. Please contact your county to find out where you should go to re-register.

Note: there is a $20.00 fee charged at the county level.

7. Address Changes: You must notify the Secretary of State of any address change within 30 days. If you have changed your

home address to a new county, you must re-register your commission with the county. Your resident county name and telephone

number is listed in the instructions portion of your new commission certificate. Please contact your county to find out where you

should go to re-register and for any fee inquiries.

8. Name Change Application: You must notify the Secretary of State of any name change within 30 days. Please attach your

former commission to this application. You must also attach a copy of a legal document showing the name change (for example,

marriage certificate, divorce decree, or other legal documentation). Upon receipt of your new commission, re-register with the county

and purchase a new notary stamp. Your resident county name and telephone number is listed in the instructions portion of your new

commission certificate. Please contact your county to find out where you should go to re-register and for any fee inquiries.

9. If you answered Yes to any of the 4 questions above, please include the appropriate documentation and return all items

to the Office of the Secretary of State. The Mailing Address is listed at the bottom of this page.

10. Minnesota Statutes, Chapters 357, 358, and 359 (which govern notaries and notarial acts) can be searched, viewed and

downloaded for free at www.revisor.mn.gov. To order a printed copy of extracts of Notary Public Laws, please contact MN

Government Publications DBA Allegra Printing at www.mngovpublications.com/home.asp.

11. If you have any questions, please call 651-296-2803 (toll free at 1-877-551-6767) and press option 3 for notary assistance.

MAIL TO:

Minnesota Secretary of State – Notary

First National Bank Building

332 Minnesota Street, Suite N201

Saint Paul, MN 55101

All of the information on this form is public. Minnesota law requires certain information to be provided for this type of filing. If that

information is not included, your document may be returned unfiled. This document can be made available in alternative formats, such

as large print, Braille or audio tape, by calling (651)296-2803/voice. For a TTY/TTD (deaf and hard of hearing) communication, contact

the Minnesota Relay Service at 1-800-627-3529 and ask them to place a call to (651)296-2803. The Secretary of State’s Office does

not dis-criminate on the basis of race, creed, color, sex, sexual orientation, national origin, age, marital status, disability, religion,

reliance on public assistance or political opinions or affiliations in employment or the provision of service.

8/2024

Criminal Background Check Form

This form only needs to be completed by notary public applicants if there is a YES answer to any

of the four questions listed on the signature page of the notary application.

The Department of Commerce uses this information to conduct criminal history checks.

PLEASE PRINT

Provide complete legal name of applicant

Last Name First Name Middle Name

Date of Birth (mo/day/yr)

Type of Application

Notary Commission

THE FOLLOWING CERTIFICATION AND AUTHORIZATION MUST BE SIGNED BY

APPLICANTS AUTHORIZING A BACKGROUND CHECK:

I, the undersigned, have made application to the Office of the Secretary of State for a

regulated notary commission.

I certify that I have provided complete and accurate answers to all questions on my

application.

I hereby request/authorize the Department of Commerce to conduct a background check

of me through their records for licensing or notary commission purposes.

Signatur ofe A pplicant

Date

MAILING INSTRUCTIONS:

This form should be completed and mailed along with the Notary Application to:

Minnesota Secretary of State - Notary

First National Bank Building

332 Minnesota Street, Suite N201

Saint Paul, MN 55101

8/2024

FFICE OF THE MINNESOTA

SECRETARY OF STATE