Identification Number Commission Date Expiration Date New Renewal DEPARTMENT OF THE TREASURY DIVISION OF REVENUE NOTARY PUBLIC APPLICATION PHONE Your County of Residence Your Date of Birth Impor

Renewal and new applicants must answer every question 111 Complete all items on this form and have it signed by a State legislator 1 Have you ever been convicted of a crime yes no If yes enclose a statement of details 2 Have you ever been a Notary P

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