APPLICATION FOR APPOINTMENT AS A TEXAS NOTARY PUBLIC
Type or Print Using Black Ink Only!
 
THIS APPLICATION MUST BE ONE PAGE, FRONT AND BACK 
  NOTAPPL 09/2003(THIS AREA FOR SEC. OF STATE USE ONLY)
 
(1) SOCIAL SECURITY #:________-_____-__________*

(2) NAME TO BE USED AS A NOTARY PUBLIC:
___________________________________________________
(LAST)                     (FIRST)                        (MIDDLE)                     (SUFFIX)

(3) MAILING ADDRESS: 
_______________________________________________________________________________ 
(STREET ADDRESS/RURAL ROUTE)                            (CITY)                                        (STATE)                (ZIP CODE)

(4) RESIDENCE COUNTY:_______________________

(5) DATE OF BIRTH:_________________________
                                            (Month/Day/Year)

(6) a. TEXAS 8 DIGIT DRIVER'S LICENSE #: OR TEXAS ID#________________________________________

b. OR DRIVER'S LICENSE # ISSUED FROM OTHER STATE: # ______________________STATE:#____________________________

(7) [ ] YES [ ] NO   IS THIS A RENEWAL? (The commission must currently be in effect for this to apply)

                     (a) If YES, give date your present commission expires_______________________________
                                                                                                                        (Month/Day/Year)
                 DO NOT SUBMIT IF YOU HAVE MORE THAN 90 DAYS REMAINING ON YOUR CURRENT TERM
                     Name in which your present commission was issued_______________________________
(8) [ ] YES [ ] NO   HAVE YOU EVER BEEN CONVICTED OF A FELONY OR CRIME INVOLVING MORAL TURPITUDE,
                                  OR,  IF THIS IS A RENEWAL,  HAS THERE BEEN ANY CONVICTION SINCE YOUR LAST APPOINTMENT?
                              If YES, submit a copy of the final conviction and statement of the facts, if any, regarding restoration of citizenship rights.
                                                APPLICATIONS ARE SUBJECT TO BACKGROUND INVESTIGATIONS
(9) [ ] YES [ ] NO   ARE YOU A LEGAL RESIDENT OF TEXAS?

I hereby apply for appointment as a Notary Public in the state of Texas, and certify that the information herein provided is true and correct and that I am not disqualified bv law or any other reason from holding the office of Notary Public. 
                                                                    X  ________________________________ 
                                                                                              SIGNATURE OF APPLICANT 
                                                                                              SIGNATURE ABOVE AND NAME #(2) MUST MATCH ====================================================================================================
                                                                                                         INFORMATION 
*The disclosure of your social security number is mandatory. Its solicitation is authorized by Chapter 406 of the Government Code and is used to maintain accuracy of the notary records . 
ELIGIBILITY: To hold the office of notary public an applicant must be at least 18 years of age and a legal resident of the State of Texas and must not have been convicted of a felony or crime involving moral turpitude. 
NAME TO BE USED AS A NOTARY PUBLIC: When asked in #2 to provide the name to be used as a Notary Public, you should enter the name exactly as you intend to sign documents when acting as a Notary Public. Your commission will be issued in the name you choose. The name can be the full legal name or any variation thereof. For instance, if your full legal name is Gloria Ann Smith, you may choose to qualify as Notary Public under the name Gloria A. Smith. There is not a statutory requirement that you use your full legal name. However, when signing as a Notary Public, you may use only  the name under which you qualified.  Some examples of a commonly used suffix are:  Sr., Jr., III. 
CRIMINAL CONVICTION: A criminal conviction does not automatically render you ineligible to hold the office of Notary Public. The application will be reviewed to make a determination on whether the
applicant is eligible to become a Notary Public. You may request copies of any information this office collects about you, and you are entitled to have incorrect information corrected. 
SIGNATURE: For Signature of Applicant you must sign in the name you will use when acting as a Notary Public. For instance, if you print the name Gloria A. Smith in #(2), you must sign
Gloria A. Smith for Signature of Applicant . 
QUESTIONS: Questions concerning the completion of the application may be directed to the Notary Public Unit at (512) 463-5705 or Texas State Notary Bureau at 1 888 463-5705 (toll free)