Notary Public Application
STEP 1: APPLICANT INFORMATION
Name of Notary
First Name
*
AS SHOWN ON DRIVER'S LICENSE OR STATE ID
Middle Name or Initial
AS SHOWN ON DRIVER'S LICENSE OR STATE ID
Last Name
*
AS SHOWN ON DRIVER'S LICENSE OR STATE ID
First + Middle Name
Full Name
Business Information
The State of Illinois requires a physical address. If none, enter "N/A" or "Self Employed" for business name and N/A for address.
Name of Employer
*
Street
*
City
*
State
*
ZIP Code
*
Identifying Information
Date of Birth
*
/
Month
/
Day
Year
Date
Driver’s License or State Identification Card Number
*
Home Address
Street
*
City
*
State
*
ZIP Code
*
County of Residence
*
Adams
Alexander
Bond
Boone
Brown
Bureau
Calhoun
Carroll
Cass
Champaign
Christian
Clark
Clay
Clinton
Coles
Cook
Crawford
Cumberland
Dekalb
Dewitt
Douglas
DuPage
Edgar
Edwards
Effingham
Fayette
Ford
Franklin
Fulton
Gallatin
Greene
Grundy
Hamilton
Hancock
Hardin
Henderson
Henry
Iroquois
Jackson
Jasper
Jefferson
Jersey
Jo Daviess
Johnson
Kane
Kankakee
Kendall
Knox
Lake
LaSalle
Lawrence
Lee
Livingston
Logan
Macon
Macoupin
Madison
Marion
Marshall
Mason
Massac
McDonough
McHenry
McLean
Menard
Mercer
Monroe
Montgomery
Morgan
Moultrie
Ogle
Peoria
Perry
Piatt
Pike
Pope
Pulaski
Putnam
Randolph
Richland
Rock Island
Saline
Sangamon
Schuyler
Scott
Shelby
St. Clair
Stark
Stephenson
Tazewell
Union
Vermilion
Wabash
Warren
Washington
Wayne
White
Whiteside
Will
Williamson
Winnebago
Woodford
City, State Zip
Contact Information
Email Address
*
example@example.com
Home Phone
*
Business Phone
*
If a business name was filled in above you must also provide the business phone number
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STEP 2: COMMISSION INFORMATION
What type of commission are you applying for?
*
New Commission
Renewal of Commission
Adding Electronic Notary to Active Notary Public Commission
Refer to your most recent notary certificate to find your commission expiration date and number. If unknown, please leave blank.
Commission Expiration Date
/
Month
/
Day
Year
Date
Commission Number
Are you requesting a Notary Public and Electronic Notary Public Commission
*
Yes
No
Name(s) of Electronic Notarization System Provider(s)?
*
Type of Device(s)? Check all that apply.
*
Desktop Computer
Laptop
Smartphone
Tablet
Other
Will you perform Notarizations remotely by means of Audio-Video Communication?
*
Yes
No
Have you had any disciplinary actions, convictions or administrative actions against you?
*
Yes
No
Please provide the type of action or conviction, date of same, and the name of the court or agency that took the action and State of the action.
*
Has your name, address or county changed since your last commission?
*
Yes
No
Please give the previous name, address and/or county
*
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STEP 3: QUALIFICATIONS & OATH
Qualification Statements
*
I am a U.S. citizen or an alien admitted for permanent residence.*
I have been a resident of Illinois for at least 30 days.*
I am age 18 or older.*
I have never been convicted of a felony.*
I am able to read and write the English language.*
I have never had a notary public commission revoked.*
If also requesting to be an Electronic Notary Public, I also certify that I will:comply with the standards set forth by Section 176.835 of the Illinois NotaryAct relating to identify proofing and credential analysis; use a third-party provider who has been certified to act as an electronic notarization system provider in the State of Illinois by the Secretary; upon request by theSecretary, promptly provide any information necessary instructions or techniques supplied by a provider that will allow the notary public’s digital certificate and electronic seal to be read and authenticated; and comply with the applicable provisions of the Illinois Notary Act, including Article VI-A.
Notarial Oath
*
I do solemnly affirm, under the penalty of perjury, that the answers to all statements on this application are true, complete, and correct; that I have carefully read the notary law of the state of Illinois; and that if appointed and commissioned as a notary public, I will perform faithfully, to the best of my ability, all notarial acts in accordance with the law. Further, my signature below authorizes the Office of the Secretary of State to conduct a background verification, including a criminal background check, to confirm the assertions and information provided in the application and to compare and use for official purposes any Illinois driver’s license or state identification card information contained in the office’s master record.
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STEP 4: IMPORTANT NEXT STEPS!
Online Order Number
If you placed an order online, please enter your order number
Acknowledgement
*
I acknowledge pressing submit does not complete the Illinois Application Process.
I acknowledge that I must mail the completed and notarized application with all original signatures, a copy of my Illinois driver’s license or State identification card, and a copy of my notary public course certificate, to the Notary Public Association in Crystal Lake for processing.
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