Free Notary Public Special Commission - Kentucky

TREY GRAYSON
Secretary of State APPLICATION FOR APPOINTMENT TO THE OFFICE OF NOTARY PUBLIC - SPECIAL COMMISSION PURSUANT to the provision of KRS 423.110(6), the undersigned applies to the Governor of Kentucky to be appointed to the Office of Notary Public-Special Commission. For this purpose, the undersigned applicant makes the following statements:

1. The name of applicant is:_____________________________________ Date of birth:___________________
(please print or type)

2. The residence address of the applicant is:_______________________________________________________
(street)

________________________________________________________________________________________
(city) (state) (zip)

3. County of residence: _________________If an out-of-state resident, the Kentucky county from which the
application is being made: ______________________. 4. Application is being made for a new appointment or a reappointment. If a reappointment, your present commission will expire:_______________(If previously a notary public - special commission and commission has expired, please check new appointment). 5. Applicant is at least eighteen (18) years of age, is a legal resident of the above-named county (if a Kentucky resident), is of good moral character, is not a convicted felon and is capable of discharging the duties imposed upon the Office of Notary Public. 6. Signature of applicant:______________________________________________________________________

CERTIFICATE OF APPROVAL BY OFFICIAL
The undersigned, an official authorized by statute to approve this application,** states that the applicant herein is of the age of eighteen (18) years of age, is a legal resident of the above-named county, (if a Kentucky resident), is of good moral character, and is capable of discharging the duties imposed by law upon Notaries Public of the Commonwealth of Kentucky. NOW, THEREFORE, by virtue of the foregoing statements I have made and the authority granted to me by statute, my approval to the foregoing application is hereby granted.
SIGNATURE:________________________________________________________________________________________ PLEASE PRINT OR TYPE NAME:______________________________________________________________________ OFFICIAL TITLE (INCLUDE COUNTY):_________________________________________________________________ OFFICIAL'S OFFICE ADDRESS:_______________________________________________________________________ **PLEASE NOTE: The Certificate of Approval must be signed by one of the following officials whose jurisdiction or district includes the county of application: Circuit Judge, Circuit Clerk, County Judge/Executive, County Clerk, Magistrate or Member of the General Assembly.

Instructions
You are applying for a Kentucky Notary Public - Special Commission. A Kentucky Notary Public Special Commission is a resident or nonresident of Kentucky, who is appointed by the Governor of Kentucky, to perform notarial acts in or outside this state covering writings prepared for recordation in this state. KRS 423.110(6). Notaries receiving the appointment to this office are specifically limited to the acts described in this paragraph. Once you have been appointed to the Office of Notary Public - Special Commission you should utilize the following signature format: "I ___________________, a Kentucky Notary Public - Special Commission, for acts performed in or outside Kentucky for recordation in Kentucky; my commission expires: _________." 1. After completing the application, mail to the Office of the Secretary of State, along with $10.00, to 148 Capitol Building, 700 Capitol Avenue, PO Box 821, Frankfort, Kentucky 40601. Checks should be made payable to the Kentucky State Treasurer. 2. After the application has been filed and approved by the Secretary of State, you will receive a Notice of Appointment. Attached to the Notice of Appointment. Attached to the Notice of Appointment will be a printed Oath of Office. Pursuant to KRS 62.010, you must take the Oath of Office within thirty (30) days after you receive your Notice of Appointment. After the oath has been administered, the written Oath of Office must be returned to the Secretary of State within thirty (30) days from the date of your Notice of Appointment letter. Upon receipt by the Secretary of State of the Oath of Office, the Governor, through the Secretary of State, will issue to the applicant the Commission to Office.

Instructions by Line:
Line 1: List your name as it is to appear on the Commission of Appointment and your birth date. Line 2: List your home address. This is where your written Oath of Office and Notice of Appointment will be mailed. Line 3: List county of application. If an out-of-state resident, designate the county from which you are making application. Line 4: Check whether this is a new appointment or a reappointment. If previously a Notary Public Special Commission and your commission has expired, please check new appointment. Please mail application along with the fee of $10.00 to: Notary Commissions PO Box 821 Frankfort, Kentucky 40602-0821

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