Free Notary Division - Maryland Secretary of State - Maryland

NOTARY DIVISION
OFFICE OF THE SECRETARY OF STATE, STATE HOUSE, ANNAPOLIS, MARYLAND 21401 (410) 974-5520

NOTARY PUBLIC NAME AND/OR ADDRESS CHANGE FORM
IF YOU CHANGED YOUR NAME OR ADDRESS SINCE YOU WERE COMMISSIONED, PLEASE COMPLETE THIS FORM AND RETURN TO THE OFFICE OF THE SECRETARY OF STATE BY MAIL. NAME CHANGE -- IF YOU HAVE CHANGED YOUR NAME SINCE YOU WERE COMMISSIONED, PLEASE COMPLETE THE FOLLOWING INFORMATION. Legal Name as it appears on commission: _______________________________________ New Legal Name: __________________________________________________________ Yes No Issue new commission with my new name: * PLEASE CHECK: NOTE: If checked "Yes", please submit a $5.00 fee payable to the Secretary of State, we will issue a commission reflecting your new name. You should also acquire a new seal reflecting your new name. The Clerk of the Court will collect an $11.00 fee when you are sworn in under your new name. Prior to receiving your new commission, you should sign your name as follows with any notarial act. [Current name], commissioned as [Name as it appears on your commission] For example: Mary Smith, commissioned as Mary Jones ADDRESS CHANGE -- IF YOUR ADDRESS HAS CHANGED SINCE YOU WERE COMMISSIONED, PLEASE COMPLETE THE
FOLLOWING INFORMATION. (No fee required)

Legal Name as it appears on commission: _____________________ Date of Birth _______ County in which you were commissioned: _____________________ Address at time of commission: _______________________________________________ City: __________________________ State: ______ Zip: __________

Former Home Phone: ________________ Former Business Phone: ___________________ New County of Residence: _____________________ New Home Address: ________________________________________________________ City: __________________________ New Home Phone: _______________ State: ______ Zip: __________

Business Phone: _________________

YOU MUST RETURN YOUR OLD COMMISSION BEFORE A NEW COMMISSION IS ISSUED. PLEASE SUBMIT WITH THIS APPLICATION A $5.00 FEE MADE PAYABLE TO THE SECRETARY OF STATE.
SIGNATURE: I SOLEMNLY AFFIRM under penalties of perjury and upon personal knowledge that the contents of the foregoing paper are true. _____________________
Date

_________________________________________
Signature must be the same as name printed above

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