The SS984N form serves as a critical tool within the state of Louisiana for maintaining the integrity and professionalism of notaries public. Crafted under the auspices of then Secretary of State Tom Schedler, this form is designed for the submission of complaints regarding unauthorized notarial acts. It includes a range of potential violations from misuse of notarial powers to engaging in fraudulent activities. The form not only requests detailed information about the alleged offender, including their name and notary ID number if applicable but also seeks comprehensive details about the complaint itself such as the nature of the violation, specific occurrences, and times and locations where infractions took place. The comprehensive design of the form reflects Louisiana's statutory requirements as outlined in La. R.S. 35:601 et seq., emphasizing the state's commitment to uphold the law's integrity concerning notarial conduct. By providing a direct line of communication to the Secretary of State’s Notary Division, the SS984N form facilitates a structured process for investigating complaints, further underscoring the state's vigilance in regulating notarial practice and ensuring accountability among its practitioners.
| Question | Answer |
|---|---|
| Form Name | Form Ss984N |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | SS984N, misrepresentation, validly, SCHEDLER |
STATE OF LOUISIANA
SECRETARY OF STATE
TOM SCHEDLER
SECRETARY OF STATE
TRANSMITTAL INFORMATION
For All Notary Filings
Notary Division (225)
Fax Numbers
(225)
Name of person filing document
Address
City |
State |
Zip Code |
Daytime phone number |
Fax number |
Email address |
|
Mailing Address: P. O. Box 94125, Baton Rouge, LA *
Office Location: 8585 Archives Ave., Baton Rouge, LA * 70809
Web Site Address: www.sos.la.gov
SS984N Rev. 08/13
|
COMPLAINT ALLEGING |
|
UNAUTHORIZED EXERCISE OF NOTARIAL POWERS |
|
La. R.S. 35:601 et seq. |
|
RETURN COMPLETED FORM TO: |
Tom Schedler |
Secretary of State Notary Division, |
Secretary of State |
P.O. Box 94125 |
|
Baton Rouge, LA 70804 |
Parish of _____________________________
Before me, the undersigned authority came and appeared the undersigned complainant, who in accordance with the provisions of La. R.S. 35:603, and being duly sworn, did depose and say that
_______________________________________________ |
_______________________ is in violation of the |
Printed name of subject of complaint |
Notary ID# if known |
following provision(s) of La. R.S. 601 et seq. (UNAUTHORIZED EXERCISE OF NOTARIAL POWERS)
Violation(s): check all that apply
_____ Commission or authority to exercise notary function is statutorily or judicially suspended.
_____ Commission or authority to exercise notary function is statutorily or administratively revoked.
_____ No longer validly commissioned.
_____ Commission in retirement status under provisions of R.S.35:202(G)
_____ No longer validly possessed of the office or position from which authority to exercise notarial functions were derived.
_____ Convicted of a felony and has not been pardoned.
_____ Not authorized by law to exercise that particular notarial function.
_____ Engaged in dishonesty, fraud, deceit, or misrepresentation.
_____ Certified as true what he knows or should have known to be false.
_____ Violated any provision of any law governing the office of notary or the exercise of notary authority.
_____ Abandoned his commission.
_____ Failed to pay over money entrusted to him in his official capacity as a notary public.
_____ Failed to satisfy any final judgment rendered against him in his official capacity as a notary public.
_____ Not authorized to exercise notarial powers.
Complainant’s statement to include details of violation(s), its nature, the dates, time(s), address(es) where violation(s) occurred and address of subject of the complaint. (attach additional page(s) if necessary):
__________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
Complainant name:_________________________________________ Phone: _________________________________
Complainant address: _______________________________________ City, State, Zip:__________________________
_____________________________________
Signature of Complainant
Sworn to and subscribed before me this ____ day of ___________, 20___
__________________________________________
Signature of notary
__________________________________________ ________________
Printed name of notary |
La. Notary ID# |