Form Np 659 007 – Fill Out and Use This PDF

Notary Public

Appointment/ Reappointment Application

Please read carefully and follow all instructions exactly!

If you do not follow the application instructions exactly, your Notary Public certificate will be denied or delayed.

To qualify for appointment as a Notary Public, you must:

•฀ Be฀at฀least฀18฀years฀of฀age

•฀ Be฀able฀to฀read฀and฀write฀English

•฀ Reside฀in฀Washington฀State฀

If฀you฀are฀a฀resident฀of฀Idaho฀or฀Oregon,฀you฀may฀become฀a฀Washington฀State฀Notary฀Public฀as฀long฀as฀you฀are฀regularly฀ employed฀in฀Washington฀State฀or฀carry฀on฀business฀in฀Washington฀State.

To apply for an appointment as a Notary Public, you must:

1.Complete the application

•฀ If฀you฀are฀a฀irst-time฀applicant฀or฀if฀you฀are฀renewing฀your฀appointment฀after฀your฀expiration฀date,฀complete฀the฀ application฀form฀in฀full.

•฀ If฀you฀are฀renewing฀your฀appointment฀before฀your฀expiration฀date,฀complete฀only฀section฀A฀Applicant Information on

the application.

•฀ Notary฀Appointment฀Name:฀In฀section฀A฀of฀the฀application,฀you฀must฀indicate฀a฀Notary฀Appointment฀Name.฀This฀is฀the฀ name฀you฀will฀use฀for฀notarizations,฀and฀is฀the฀name฀that฀will฀appear฀on฀your฀notary฀seal฀and฀certiicate.฀You฀cannot use฀only฀your฀last฀name฀and฀a฀single฀initial฀(such฀as฀J.฀Smith),฀or฀only฀a฀single฀name฀(such฀as฀Smitty).

•฀ Full฀legal฀name:฀In฀section฀A฀of฀the฀application,฀you฀must฀indicate฀your฀full฀legal฀name฀(First,฀Middle,฀Last)฀no฀ initials.฀Examples฀of฀documents฀containing฀your฀full฀legal฀name฀are฀a฀passport฀or฀a฀state฀issued฀driver฀license฀or฀

identification card.

2.Obtain a $10,000 surety bond

•฀ You฀must฀obtain฀a฀$10,000฀surety฀bond฀for฀your฀4-year฀term฀from฀any฀insurance฀company฀qualiied฀to฀write฀surety฀

bonds in this state.

•฀ The฀bond฀must฀be฀speciically฀for฀your฀Notary฀Public฀appointment.฀No฀other฀insurance฀you฀and/or฀your฀company฀may฀

have฀will฀sufice.

•฀ Please฀do฀not฀send฀us฀your฀Errors฀and฀Omissions฀policy฀if฀you฀have฀one.

3.Submit the application

Your฀application฀must฀contain:

•฀ your฀completed฀application฀form

•฀ a฀copy฀(keep฀the฀original฀for฀your฀records)฀of฀your฀$10,000฀surety฀bond

•฀ a฀$30฀application฀fee฀(check฀or฀money฀order฀made฀out฀to฀Department฀of฀Licensing).฀This฀fee฀is฀non-refundable.

Submit฀it฀to:

Notary฀Public฀Program Department฀of฀Licensing PO฀Box฀35001 Seattle,฀WA฀98124-3401

4.Obtain your Notary seal or stamp after you receive your Notary Public Certificate from us

•฀ We฀do฀not฀supply฀your฀Notary฀seal฀or฀stamp.

•฀ Present฀a฀photocopy฀of฀your฀Notary฀Public฀Certiicate฀to฀the฀vendor฀you฀choose฀to฀make฀your฀stamp฀or฀seal.

The laws relating to Notaries Public

•฀ As฀a฀Washington฀State฀Notary฀Public฀you฀are฀expected฀to฀know฀and฀abide฀by฀our฀notary฀public฀laws฀which฀you฀can฀ind฀

at www.dol.wa.gov/business/notary.

•฀ You฀are฀personally฀liable฀for฀every฀notary฀act฀you฀perform.฀We฀strongly฀recommend฀you฀take฀a฀Notary฀class฀after฀ receiving฀your฀certiicate.฀Vist฀our฀website฀at฀www.dol.wa.gov/business/notary for a list of classes.

Change of Address

If฀your฀address฀changes,฀you฀must฀notify฀us฀via฀e-mail฀at฀notaries@dol.wa.gov,฀or฀by฀mail฀at฀Notary฀Public฀Program,฀ Department฀of฀Licensing,฀PO฀Box฀9027,฀Olympia,฀WA฀98507-9027.฀Include฀your฀name฀as฀shown฀on฀your฀notary฀certiicate฀ along฀with฀your฀date฀of฀birth,฀and฀your฀previous฀and฀new฀addresses.฀WAC฀308-30-060

Questions?

Call฀us฀at฀(360)฀664-1550.

Notary Public

Appointment/ Reappointment Application

AApplicant information

Notary Appointment Name (Name as you will sign notarizations and as you would like it to appear on your notary seal/certificate) See page 1 Instructions

Mailing฀address฀(PO Box or street including apartment/suite #, City, State, ZIP code)

Full฀legal฀name฀(First, Middle, Last) no initials

Check฀one

I฀am฀a฀Washington฀resident

I฀am฀an฀Oregon฀resident฀who฀works฀or฀does฀business฀in฀Washington

I฀am฀an฀Idaho฀resident฀who฀works฀or฀does฀business฀in฀Washington

Answer฀the฀following

Can฀you฀read฀and฀write฀English?฀ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

Have฀you฀ever฀been฀a฀Notary฀Public฀in฀the฀state฀of฀Washington?฀. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No If yes,฀under฀what฀names?฀฀

BEndorsements by three residents of Washington State who are not related to you (no family members)

Endorser #1
I,	,฀being฀a฀person฀eligible฀to฀vote฀in฀the฀state฀of

฀Printed฀name฀of฀endorser

	Washington,฀believe฀the฀applicant฀for฀a฀notary฀appointment,฀		, who is not
฀	Printed฀name฀of฀applicant
	related฀to฀me,฀to฀be฀a฀person฀of฀integrity฀and฀good฀moral฀character฀and฀capable฀of฀performing฀notarial฀acts.

X

฀		Signature฀of฀endorser฀	Date฀signed
฀		Address฀of฀endorser฀(PO฀Box฀or฀street,฀City,฀State,฀ZIP฀code)
Endorser #2
I,			,฀being฀a฀person฀eligible฀to฀vote฀in฀the฀state฀of

฀Printed฀name฀of฀endorser

	Washington,฀believe฀the฀applicant฀for฀a฀notary฀appointment,฀		, who is not
฀	Printed฀name฀of฀applicant
	related฀to฀me,฀to฀be฀a฀person฀of฀integrity฀and฀good฀moral฀character฀and฀capable฀of฀performing฀notarial฀acts.

X

฀		Signature฀of฀endorser฀	Date฀signed
฀		Address฀of฀endorser฀(PO฀Box฀or฀street,฀City,฀State,฀ZIP฀code)
Endorser #3
I,			,฀being฀a฀person฀eligible฀to฀vote฀in฀the฀state฀of

฀Printed฀name฀of฀endorser

	Washington,฀believe฀the฀applicant฀for฀a฀notary฀appointment,฀		, who is not
฀	Printed฀name฀of฀applicant
	related฀to฀me,฀to฀be฀a฀person฀of฀integrity฀and฀good฀moral฀character฀and฀capable฀of฀performing฀notarial฀acts.

X

฀	Signature฀of฀endorser฀	Date฀signed
฀	Address฀of฀endorser฀(PO฀Box฀or฀street,฀City,฀State,฀ZIP฀code)

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CApplicant information

Answer฀the฀following

1.฀ Other than a traffic infraction,฀have฀you฀been฀convicted฀of฀a฀crime,฀misdemeanor฀or฀felony฀in฀this state,฀any฀other฀state,฀any฀other฀jurisdiction,฀or฀by฀the฀federal฀government฀within฀the฀past฀ten฀years? . . . . . . . ฀ Yes฀ ฀ No

2.฀ Is฀there฀a฀criminal฀complaint,฀accusation,฀or฀information฀presently฀pending฀against฀you,฀or฀are

you฀currently฀under฀indictment฀in฀this฀state,฀any฀other฀state,฀any฀other฀jurisdiction,฀or฀by฀the

federal฀government? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ฀ Yes฀ ฀ No

3.฀ Has฀any฀professional฀or฀occupational฀license,฀certiication,฀or฀permit฀held฀by฀you,฀been฀ined, suspended,฀revoked,฀refused฀or฀denied฀in฀this฀state,฀any฀other฀state,฀any฀other฀jurisdiction,฀or

by฀the฀federal฀government? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ฀ Yes฀ ฀ No

4.฀ Other than a divorce or bankruptcy,฀have฀you฀ever฀had฀a฀civil฀court฀order,฀verdict,฀or฀judgment entered฀against฀you฀in฀any฀court฀of฀competent฀jurisdiction฀in฀this฀state,฀any฀other฀state,฀any฀other

jurisdiction,฀or฀by฀the฀federal฀government? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ฀ Yes฀ ฀ No

Please explain all “Yes” answers below. You may attach additional sheets, if necessary.

If you answered “yes” to questions #1 or #2,฀please฀provide฀the฀following฀information:

Charge(s)

Name(s)฀under฀which฀you฀were฀convicted

Where฀convicted฀(City, County, State)Date(s)฀of฀convictions

What฀were฀you฀convicted฀of฀and฀what฀was฀your฀sentence?

If you answered “yes” to question #3,฀please฀provide฀the฀following฀information:

Reason฀for฀action฀and฀resolution฀(if฀any)

If you answered “yes” to question #4,฀please฀provide฀the฀following฀information:

Type฀of฀civil฀court฀order,฀verdict,฀or฀judgment

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STOP!

You (the Notary Public applicant) must complete this page in front of a Notary Public.

If all of the instructions below are not followed correctly, you will have to complete and submit

a new Declaration of Applicant and your Notary Public appointment will be delayed.

Instructions for the applicant

1.฀ The฀Notary฀Public฀will฀properly฀identify฀you฀and฀place฀you฀under฀oath.

2.฀ After฀the฀Notary฀places฀you฀under฀oath,฀you฀must:

•฀ Swear฀to฀or฀afirm฀that฀the฀information฀in฀the฀Declaration฀of฀Applicant฀is฀true.

•฀ Print฀your฀Notary฀Appointment฀Name฀on฀the฀Declaration฀exactly฀as฀it฀appears฀in฀section฀A฀of฀your฀application.

•฀ Sign฀the฀Declaration฀in฀front฀of฀the฀Notary,฀using฀your฀Notary฀Appointment฀Name฀exactly฀as฀it฀appears฀in฀section฀A฀of฀

your application.

•฀ Date฀the฀Declaration฀in฀front฀of฀the฀Notary.

Instructions for the Notary Public

1.฀ Conirm฀the฀identity฀of฀the฀applicant฀and฀place฀him/her฀under฀oath.

2.฀ Have฀the฀applicant฀swear฀to฀(or฀afirm)฀the฀information฀in฀the฀Declaration฀of฀Applicant.

3.฀ Have฀the฀applicant฀sign฀and฀date฀the฀Declaration฀of฀Applicant.

4.฀ Fill฀in฀the฀name฀of฀the฀county฀in฀which฀you฀are฀notarizing.

5.฀ Date฀the฀Declaration฀of฀Applicant.฀This฀date฀must฀match฀the฀date฀the฀applicant฀signed.

6.฀ Sign฀your฀name฀exactly฀as฀it฀appears฀on฀your฀stamp฀or฀seal.

7.฀ Print฀your฀name฀under฀your฀signature.฀Your฀title฀is฀“Notary฀Public.”

8.฀ Fill฀in฀the฀expiration฀date฀for฀your฀Notary฀Public฀appointment.

9.฀ Afix฀your฀stamp฀or฀seal฀in฀the฀space฀indicated.

Failure to follow any of these instructions by you or the Notary will result in the delay of your license.

DDeclaration of applicant

I,,฀฀solemnly฀swear฀or฀afirm฀under฀penalty฀of

perjury฀that฀the฀personal฀information฀I฀have฀provided฀in฀this฀application฀is฀true,฀complete,฀and฀correct;฀that฀I฀have฀carefully฀ read฀the฀materials฀available฀at฀the฀Notary฀Public฀website฀describing฀the฀duties฀of฀a฀notary฀public฀in฀and฀for฀the฀state฀of฀ Washington;฀and,฀that฀I฀will฀perform฀to฀the฀best฀of฀my฀ability,฀all฀notarial฀acts฀in฀accordance฀with฀the฀law.฀I฀have฀carefully฀ read฀the฀questions฀in฀the฀foregoing฀application฀and฀have฀answered฀them฀completely,฀and฀pursuant฀to฀RCW฀9A.72.085,฀ I฀declare฀under฀penalty฀of฀perjury฀under฀the฀law฀of฀the฀state฀of฀Washington฀that฀my฀answers฀and฀all฀statements฀made฀by฀ me฀herein฀are฀true฀and฀correct.฀Should฀I฀furnish฀any฀false฀information฀in฀this฀application,฀I฀hereby฀agree฀that฀such฀act฀shall฀ constitute฀cause฀for฀the฀denial,฀suspension฀or฀revocation฀of฀my฀appointment฀as฀a฀notary฀public฀in฀the฀state฀of฀Washington.

					Applicant:
					insignfront฀hereof฀฀		X
฀							Sign฀using฀your฀Notary Appointment Name฀		Date฀signed
State฀of฀Washington					a notary
County฀of฀									฀appeared฀before฀me,
On this day,				,
	Date฀฀			Applicant฀full฀legal฀name
signed฀this฀Declaration฀of฀Applicant,฀and฀swore฀(or฀afirmed)฀that฀he/she฀understood฀its฀contents฀and฀that฀its฀contents฀
are truthful.
฀							Signature
			(Seal฀or฀stamp)
							Printed฀or฀stamped฀name
							Title
฀							My฀appointment฀expires฀฀

Once filed, this application is a public record and is subject to public disclosure. RCW฀42.56

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