Application for Notary Public Change of Name

I. Applicant Information

1. Full Name: [Your Name]

2. Previous Name: [Previous Name]

3. New Name: [New Name]

4. Date of Birth: [Date of Birth]

5. Email Address: [Your Email]

II. Reason for Name Change

[Provide a detailed explanation for the name change]

III. Verification of Identity

Primary Identification Document:

• Type: [Type of Identification Document]

• Number: [Identification Number]

• Issuing Authority: [Issuing Authority]

• Expiry Date: [Expiry Date]

Secondary Identification Document (if applicable):

• Type: [Type of Identification Document]

• Number: [Identification Number]

• Issuing Authority: [Issuing Authority]

• Expiry Date: [Expiry Date]

IV. Acknowledgment of Application

I, [Your Name], hereby declare that the information provided above is true and accurate to the best of my knowledge.

V. Notary Public Details

1. Current Notary Public Name: [Current Notary Public Name]

2. Notary Commission Number: [Notary Commission Number]

3. State of Commission: [State of Commission]

4. Expiry Date of Commission: [Expiry Date of Commission]

VI. Signature

[Your Name] (Printed Name):

Date of Sign: (Date of Sign):

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