Dos 0033 F L A Form PDF Details

The process of becoming a Notary Public in New York involves a series of steps detailed in the DOS 0033 F L A form provided by the New York State Department of State Division of Licensing Services. This form contains comprehensive instructions for applicants, beginning with a mandate to read all sections carefully to avoid the inconvenience of having an incomplete application returned. Highlighting the form's complexities, it covers everything from the basic submission requirements, such as the $60 fee and a completed application, to specific details like the need for your name to conform to your signature and the prohibition against using only a P.O. Box as your address. It also touches on the importance of the Oath of Office, which must be signed in the presence of a commissioned Notary. Furthermore, the form includes a detailed Privacy Notification section, explaining the legal justification for collecting personal information such as Social Security and Employer Identification numbers and how this information might be used, especially in relation to tax and child support enforcement. The instructions also cover exemptions for certain professionals like attorneys and court clerks, who, despite their roles, are not exempt from the application fee. Addressing the logistical aspects, it requires a street address for New York State business for non-resident notaries and emphasizes the automatic expiration of Notary Public commissions four years from the effective date, highlighting the importance of notifying the division of any address changes to continue receiving pertinent notifications.

QuestionAnswer
Form NameDos 0033 F L A Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesnys notary public, new york state notary public application, nys notary application form, new york notary get

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New York State

DEPARTMENT OF STATE

Division of Licensing Services

P.O. Box 22065

Albany, NY 12201-2065

Customer Service: (518) 474-4429 www.dos.ny.gov

Notary Public Application Instructions

Please read all instructions carefully, as incomplete applications

4.

Privacy Notification

 

The Department of State is required to collect the federal Social

will be returned. Send these materials to the address indicated on

 

 

Security and Employer Identification numbers of all licensees.

the reverse side of this application. Notary Public commissions

 

 

The authority to request and maintain such personal information

automatically expire four years from the effective date. It is

 

 

is found in §5 of the Tax Law and §3-503 of the General

important that you notify this division of any changes in your

 

 

Obligations Law. Disclosure by you is mandatory. The

address so you will continue to receive renewal notices and other

 

 

information is collected to enable the Department of Taxation

notifications pertinent to your commission.

 

 

and Finance to identify individuals, businesses and others who

 

 

 

 

Oath of Office Instructions

 

have been delinquent in filing tax returns or may have

To qualify for appointment, an oath of office must be signed in the

 

underestimated their tax liabilities and to generally identify

 

persons affected by the taxes administered by the Commissioner

presence of a commissioned Notary and submitted to the Department of

 

 

of Taxation and Finance. It will be used for tax administration

State with your completed application and $60 fee. An identification

 

 

purposes and any other purpose authorized by the Tax Law and

card, stating the effective and expiration dates of your four-year

 

 

may also be used by child support enforcement agencies or their

commission, will be mailed to you directly by the Department of State.

 

 

authorized representatives of this or other states established

 

 

 

 

 

 

 

 

pursuant to Title IV-D of the Social Security Act, to establish,

 

 

 

 

modify or enforce an order of support, but will not be available

Application Instructions

 

to the public. A written explanation is required where no

1. The name printed in which you wish to be commissioned must

 

number is provided. This information will be maintained in the

 

 

conform exactly to the signature that will be used as a notary

Licensing Information System by the Director of Administration

and Management, at One Commerce Plaza, 99 Washington

public. Initials may be used, as in John A. Doe or J. Arthur Doe,

Avenue, Albany, NY 12231-0001.

but NOT J. Doe or J.A. Doe.

 

2.The use of a P.O. Box as the only address is not acceptable. A street address is required. County clerk employees should use the county clerk address. Non-resident notaries must use the street address of their New York State business.

3.Examination admission requirements: You must have taken and passed the NYS Notary Public Examination. Examination results are only valid for a period of two years. If you are an attorney who is currently a member of the New York State Bar or a court clerk of the Unified Court System, appointed to that position after taking a Civil Service promotional examination in the court clerk series of titles you are not required to have taken and passed the examination. Attorneys and court clerks are NOT exempt from the application fee.

Return this original application (no photocopies) along with:

A non-refundable $60 fee. You may pay by check or money order made payable to the Department of State or charge any fee to MasterCard or Visa, using a credit card authorization form. Do not send cash. A $20 fee will be charged for any check returned by your bank.

(Note: The $60 fee includes the $40 State fee and the $20 County fee)

County Clerk Employees Only

You must include a notarized fee exemption statement in lieu of the fee.

DOS-0033-f-l-a Instructions (Rev. 07/14)

Notary Public Application Instructions

FOR OFFICE USE ONLY

UNIQUE ID:

CASH NUMBER:

NYS DEPARTMENT OF STATE

FEE

DIVISION OF LICENSING SERVICES

$60

PO Box 22065

 

 

ALBANY, NY 12201-2065

NOTARY PUBLIC APPLICATION

PLEASE TYPE OR PRINT & RETURN THIS ORIGINAL FORM NOTE: THIS FORM MAY NOT BE USED TO RENEW YOUR LICENSE

NAME IN WHICH YOU WISH TO BE COMMISSIONED (MUST CONFORM TO SIGNATURE)

LAST NAME

FIRST NAME

MIDDLE

SOCIAL SECURITY NUMBER (see privacy notification) FEDERAL ID NUMBER (see privacy notification)

DAYTIME PHONE NUMBER

NYS HOME ADDRESS: (if your legal residence is outside of NYS skip this section & complete the “NYS Business Name & Address” below

STREET ADDRESS:

CITY:

NY

ZIP CODE:

COUNTY:

NYS BUSINESS NAME:

NYS BUSINESS STREET ADDRESS:

CITY:

NY

ZIP CODE:

COUNTY:

1.The date you passed the NYS Notary Public Examination (see exemptions on reverse side) ____________________

2.Are you 18 years or older? _______________________________________________________________________

3.Are you currently a member of the NYS Bar?_________________________________________________________

4.Are you currently a Court Clerk of the Unified Court System, appointed to that position after taking a civil service promotional examination in the court clerk series titles?_________________________________________________

5.Have you ever been convicted of a crime or offense (not a minor traffic violation) OR has any license, commission or registration ever been denied, suspended or revoked in this state or elsewhere? ___________________________

(If yes, you must include details/documentation)

6.Are there any criminal charges (misdemeanor or felony) pending against you in any court in this state or elsewhere? (If yes, you must submit a copy of the accusatory instrument indictment, criminal information or complaint)

YES YES

YES

YES

YES

NO NO

NO

NO

NO

I subscribe and affirm, under the penalties of perjury, the statements in this application are true and correct.

Applicant Signature X

Date

OATH OF OFFICE

FOR OFFICE USE ONLY

APPT.

DATE:

UNIQUE ID:

LAST NAME

FIRST NAME

MIDDLE

 

 

 

NYS HOME ADDRESS: (if your legal residence is outside of NYS skip this section & complete the “NYS Business Name & Address” below

STREET ADDRESS:

CITY:

NY

ZIP CODE:

COUNTY:

 

 

 

 

 

 

 

NYS BUSINESS NAME:

 

 

 

 

 

 

 

NYS BUSINESS STREET ADDRESS:

 

 

 

 

 

 

 

CITY:

NY

ZIP CODE:

COUNTY:

 

 

 

 

 

 

 

Oath of Office

State of New York

County of

I do solemnly swear (or affirm) that I will support the Constitution of the United States and the Constitution of the State New York, and that I will faithfully discharge the duties of the office of Notary Public for the State of New York according to the best of my ability.

Applicant Signature X _____________________________________ Date ___________

Sworn to before me on this _________ day of ________________

 

___________________________________

 

(County Clerk or Notary Public)

 

DOS-0033-f-l-a (Rev. 07/14)

Notary Public Stamp

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