Free Notary Public Form Termination of Commission due to Death 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 DEATH
PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK. READ INSTRUCTIONS BEFORE FILLING OUT FORM.

Notary Commission No: Notary Commission Name: Resident Street Address (prior to death):

Commission Expiration: Date of Death Employer Business Name & Address:

Name and Address of Heir or Personal Representative:

Daytime Phone Number of Heir or Personal Representative:

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Signature of Heir or Personal Representative Please send the Notary Journal with this form. The Seal should be destroyed.

Date

Within 30 days of termination of a notary public's commission as a result of death, an heir or personal representative of the notary public shall file the notary public's notarial records with the Secretary of State, unless the notary public entered into a written agreement with his/her employer pursuant to OAR 160-100-360 and OAR 160-100-340.

509 (Rev. 11/02)