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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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NOTARY PUBLIC LEGAL NAME CHANGE
PLEASE TYPE OR PRINT LEGIBLY IN BLACK OR DARK BLUE INK. ALL SECTIONS MUST BE COMPLETED. FILING THIS NAME CHANGE DOES NOT CHANGE YOUR COMMISSION EXPIRATION DATE
Use this form only if you are not ordering a new seal or providing a new signature. I wish to continue using the name under which I was originally commissioned. This is an official name change notification only. Notary Commission No: Commission Expiration:
Notary Commission Name: (Name on your official seal)
New legal name:
Reason for change:
Current Address where notary materials should be mailed
Current Business Name & Address:
Current Resident Street Address (If different from mailing address above):
Daytime Phone Number & Extension:
Home Phone Number:
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Current Commission Signature
Effective date of change
Please continue to use your current seal and sign your "old" name until your commission expires.
518 (New. 10/08)