Free Notary Public Form Termination of Commission form - Oregon

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STATE OF OREGON Corporation Division ­ Notary 255 Capitol Street NE, Suite 151 Salem, OR 97310-1327 503-986-2593 FAX 503-986-2300 FilingInOregon.com/notary

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TERMINATION OF NOTARY PUBLIC COMMISSION DUE TO RESIGNATION
IF YOU ARE MOVING OUT OF STATE, PLEASE PROVIDE AN ADDRESS AND PHONE NUMBER WHERE YOU CAN BE REACHED
PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK. READ INSTRUCTIONS BEFORE FILLING OUT FORM.

Notary Commission No: Notary Commission Name: Mailing Address:

Commission Expiration:

Employer Business Name & Address:

Resident Street Address (If different from mailing address above):

Daytime Phone Number & Extension:

Home Phone Number:

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Reason for resignation:

Effective Date of Resignation: *Journal Storage Address:

Date of Journal Storage: Describe Exact Location of Journal at Storage Address:

Signature

Date

A notary public whose commission was terminated because of resignation shall arrange for the storage of his/her notarial records, in any form and at any location within 30 days following resignation. The records or any reproduction of the records must be readable and the notary public must be able to obtain possession of such records within 15 days of receipt of a request for such records pursuant to OAR 160-100-320(1). A notary public shall store such records for a period of seven years after the date of resignation. After the seven-year period, the notary public may destroy such records pursuant to OAR 160-100-320(3). *or a Letter of Retention agreement with employer pursuant to OAR 160-100-360.

508 (Rev. 05/03)