Kern Valley State Prison and Lerdo County Jail Notary Services

2) Additional information explained. Or Other Notary Services Not Listed Above:
3) Download Your Documents Here That You Need Me To Use

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https://form.jotform.com/93275529229163
4) Termination of DDP: Secretary of State File # From DDP Registration Application:
5) POWER OF ATTORNEY ONLY: During the POA notary assignment, if the inmate changes his/her mind on who he/she wants to be his/her agent on the POA form(s). DO YOU ACCEPT or DO NOT ACCEPT name changes to another person on the POA form(s). Notary assignment will be cancelled if he/she requests/demands agent(s) name change on POA, only if you do not approve name changes on POA. See Contract*

YES, I ACCEPT the agent(s) name changes to someone else other than me on the POA, if the inmates say he wants someone else.NO, I DO NOT ACCEPT the agent(s) name changes to someone else. My name will be on the POA form and I will be the primary agent on the POA unless I specify different. As well I say that there is a secondary agent on the POANOT APPLICABLE FOR MY NEEDS
Contact Paragraph #6: If your application is not accepted by the receiving parties, department, organization or entity because the name (first, middle or last) was incorrect or incorrect date of birth or incorrect Social Security Number (NOT MY FAULT). If you decide to redo your request again due to the mistakes mentioned above and if you decide that you do need my service again. My service fee will be charged again (full price: $125/$155/$200) to visit the inmate again to sign the documents and notarize his/her signature and mail the documents back to you.
6) Your Current Legal Name. I need your current legal name to complete your requested document: Power of Attorney (you will be known as the Primary Agent), DDP, Bank Service Request, etc. If your name is not correct, it will be rejected by receiving agency (See Contact #6):*

PrefixFirst Name (Primer nombre)Full Middle Name - No Initials (Segundo nombre)Last Name. (Apellido)Suffix
7) Your Date of Birth:
Example: 01/01/1900
8) Your Mailing Address:*

Street Address / Apartment #, Suite #, Room # (Dirección)

Apartment #, Suite #, Room #

City (ciudad)State / Province (el estado)

Postal / Zip Code
9) Your Cell/Contact Phone Number:*
Please enter a valid phone number.
10) Your Email Address:*
example@example.com
11) Drivers License or State Issue ID - Front and Back;*

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POWER OF ATTORNEY -

SUCCESSOR/SECONDARY ATTORNEY-IN-FACT

Only Fill Out This Section If You Want to add a Secondary Agent For The Power Of Attorney (POA)

#24 thru #26: SUCCESSOR AGENT: if you want to add a Successor Secondary Agent for the POA. This is only if the first agent named shall die, become incompetent, resign or refuse to accept the office of agent. Each agent is to act alone and successively, in the order named as successor to such agent:
24) Secondary Agent - Please check one:*

Yes. Add Secondary AgentNOT APPLICABLE FOR MY NEEDS
25) SUCCESSOR AGENT: if you wish a Secondary Successor Agent for Power of Attorney (See Contact #6) :

PrefixFirst Name (Primer nombre)Middle Name - (No Initials) Segundo nombre)Last Name. (Apellido) Suffix
26) Secondary Agent Address:

Street Address (Dirección)

Street Address Line 2

City (ciudad)State / Province ( (el estado)

Postal / Zip Code (código postal)

CHILD PASSPORT, GUARDIANSHIP LETTER, TRAVEL OUTSIDE THE UNITED STATES AND/OR WRITTEN CONSENT FOR MINOR TO VISIT A STATE INMATE

This section is getting permission from parent that is locked up in prison or county jail. I require information on the minor child(ren) that your wanting to get a Passport, Guardianship Letter and/or Permission to Travel Outside the United States or other types of documents
27) Fill out this section if you need several documents that require permission for the child.*

Yes, I need permission from parent for Child(ren) Passport BookYes, I need permission from parent for Child(ren) Passport CardYes, I need permission from parent for Child(ren) Passport Book and Passport CardYes, I need permission from parent for a Guardianship Letter for child(ren)Yes, I need permission from parent for Child(ren) to Travel Outside the United StatesYes, I need a CDCR Written Consent for Minor(s) to Visit State InmateNOT APPLICABLE FOR MY NEEDSOther
28) What other type of documents do you need permission from parent
29) Full Name of Adult Being Responsible and who is Accompanying Child(ren)

First NameMiddle NameLast NameSuffix
30) Driver’s License Number of Adult
31) Passport Number Needed Only If Traveling Out of the USA.
32) Country/Countries To Be Visited By Minor(s). Only If Traveling Out of the USA.
33) Traveling: Depart The USA On This Date:

MonthDayYear
Date
34) Traveling: Returning The USA On or After This Date:

MonthDayYear
Date

35-1 Child Name

First NameMiddle NameLast NameSuffix
35-2 Child DOB
Example: 01/01/1990
35-3 Age of Child
35-4 Child Passport Number/ID Number. Need to travel outside the UNITED STATES
Example TR12345678
35-5 Child Was Born

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
36-1 Child Name

First NameMiddle NameLast NameSuffix
36-2 Child DOB
Example: 01/01/1990
36-3 Age of Child
36-4 Child Passport Number/ID Number. Need to travel outside the UNITED STATES
Example TR12345678
36-5 Child Was Born

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
37-1 Child Name

First NameMiddle NameLast NameSuffix
37-2 Child DOB
Example: 01/01/1990
37-3 Age of Child
37-4 Child Passport Number/ID Number. Need to travel outside the UNITED STATES
Example TR12345678
37-5 Child Was Born

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
38-1 Child Name

First NameMiddle NameLast NameSuffix
38-2 Child DOB
Example: 01/01/1990
38-3 Age of Child
38-4 Child Passport Number/ID Number. Need to travel outside the UNITED STATES
Example TR12345678
38-5 Child Was Born

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Declaration of Domestic Partnership
Name Change Only

#39 & #40: Declaration of Domestic Partnership - Only if "YOU" want to change your MIDDLE NAME and/or LAST NAME only.
39) For DP1 - Declaration of Domestic Partnership:*

Yes, I want to change my middle and or last name to his on the DP1.No, I do not want to change my last name on the DP1 - Leave as is.NOT APPLICABLE FOR MY NEEDS
40) For DP1 - If you want to change your MIDDLE NAME and/or LAST NAME - Your Name Change Only:

Your Date of Birth 00/00/0000Your New Middle Name. Only fill out if you want to change your middle name. Your New Last Name. Only fill out if you want to change your last.
WHAT TO SUBMIT TO SACRAMENTO TO BE REGISTERED

AS DOMESTIC PARTNERS

** Mail your completed application "Declaration of Domestic Partnership" (DP-1)

** Two Notarized Acknowledgments (Partner #1 and Partner #2)

** filing fee and fee for each certified copy (check or money order) NO CASH

https://form.jotform.com/Zekriv/example-of-completed-domestic-partn

Revocation of POA

A power of attorney revocation form allows a person to cancel and void a previously authorized power of attorney. Once a revocation is signed by the principal, the power of attorney is immediately terminated.
Notice of the cancellation should be given to all agents and involved parties via certified mail.
Additional $10.00 for each certified mail..
50) Revocation Of Power Of Attorney: Cancel and void a previously authorized power of attorney..*

Yes, Inmate wants to Replace his current POA with a New POANOT APPLICABLE FOR MY NEEDS
51) Inmate Gave POA to Agent

First NameMiddle NameLast NameSuffix
52) Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
53) Secondary Agent: Name of Person Who The Inmate Gave POA to Agent

First NameMiddle NameLast NameSuffix
54) Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
55) Power of Attorney Dated that Gave Power to Agent
Example: 01/01/1990

66) Inmates Mothers / Parents Name (LAST Name Birth/Before Marriage/Domestic Partnership)

Parent First NameParent Middle NameParent Last Name at BirthSuffix
67) Mothers City, State and Country of Birth

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
68) Inmates Father /Parents Name (LAST Name Birth/Before Marriage/Domestic Partnership)

Parent First NameParent Middle NameParent Last Name at BirthSuffix
69) Fathers City, State and Country of Birth

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
WHAT TO SUBMIT FOR A CERTIFIED COPY OF A BIRTH CERTIFICATE

** Completed "Application for Certified Copy of Birth Record" (VS 111).

** Notarized sworn statement.

** Starting fee per copy requested $29.00 each (check or money order) NO CASH.

Request for Release of Impounded Vehicle:

Fill this area if you request a Notariezed letter to release a vehicle from a tow yard facility.
70) Vehicle impound: YES, YOU WANT TO RELEASE OF IMPOUNDED VEHICLE or it’s NOT APPLICABLE for your needs*

YesNOT APPLICABLE FOR MY NEEDS
71) Registration Vehicle Owners Name

First NameMiddle NameLast NameSuffix
72) Year of vehicle
73) Make of vehicle
74) Model of vehicle
75) License Plate Number of vehicle
76) VIN Number of vehicle
77) Date vehicle was towed
Example: 01/01/1990
78) Towing Company/Tow Yard Name

CONTRACT:
This Agreement is made between Esequiel "Zeke" Rivera (Notary Public/Process Server) and you the client who hired my services and inmate. This is for the purpose of retaining my Services.

1) “Notary Service Fee” shall be paid upfront to Zekes Mobile Notary, in the amount quoted, before notary service assignment can start.
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2) When filling out my request for services. Please enter the current legal names (First, Middle and Last Names) of all interesting parties. If there is a suffix; Jr., III, etc., include this in the suffix box.

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3) Legal names (First, Middle and Last Names) of all parties is required for Declaration of Domestic Partnership, Termination of Domestic Partnership, Power of Attorney and Birth Certificate requests.

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4) You will get a picture image of the application to confirm the information is correct, before I print your application and visit the inmate for signatures and notary services.

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5) POWER OF ATTORNEY AGENT(s) ASSIGNMENT:

During the notary assignment, if the principal (inmate) changes his/her mind who he/she wants to be his/her agent(s) on the Power of Attorney form(s). This is solely on their own decision based solely upon what they want. You must check if YOU ACCEPT or DO NOT ACCEPT the name changes. The Principal is the main author in the Power of Attorney and it is their decision who he/she wants to be their agent(s).

You (client) must advise me the notary public before I go on the notary assignment if you want me to deny his/her request to change agent(s).

There will be no full refunds of any kind if the inmate changes his/her mind on the Power of Attorney form(s). If you require your money back, it is suggested that you get with the principal (inmate) and/or the new agent(s) who he/she wanted on the Power of Attorney.

The only refund of monies will be refunded will be half of my service fee, only if you check; "NO, I DO NOT ACCEPT agent(s) name changes to someone else."

You must discuss this issue with the inmate who he/she will want to be the agent(s) on the Power of Attorney form.

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6) If your application is not accepted by the receiving parties, department, organization or entity because the name (first, middle or last) was incorrect or incorrect date of birth or incorrect Social Security Number (NOT MY FAULT). If you require to redo your request again and if you decide that you do need my service again. My service fee will be charged again (full price: $125/$155/$200) to visit the inmate again to sign the documents and notarize his/her signature. As well, your documents will be mailed to you again by USPS and you will get a tracking number of your envelope.
I make every effort to make sure both that your information and the inmates information is correct before traveling to Lerdo or KVSP for the notary service.

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7) If the client above fails to pay for services when due, Zekes Mobile Notary has the option to treat such failure to pay as a material breach of this Contract, and may cancel this Contract and/or seek legal remedies.
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8) EMERGENCY NOTARY SERVICE: if you request and require Emergency Notary Service. There will be an additional fee for emergency services.
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9) TERM: This Contract will terminate automatically upon completion of notary assignment and in addition to other Service Fees are paid in full to Zekes Mobile Notary, for the Services performed according to the guidelines of this Contract. Upon termination of this Contract, Zekes Mobile Notary, will return all Notarized Documents created, or controlled by Zekes Mobile Notary to you (client).
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10) It’s the client’s responsibility to make sure that the inmate is still housed at the sending facility and will be available at the time of arrival for notary signature(s). I don’t want to waste your time and your money because if for any reason signing does not occur because the inmate refuses to sign, refuses to meet with me or they were transferred out, appointment will be considered a "NO SHOW": No Refund.
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11) DISCLOSURE REGARDING LICENSING: ZEKES MOBILE NOTARY SERVICES IS NOT LICENSED AS AN ATTORNEY OR ANY OTHER LEGAL PROFESSIONAL, NOR IS IT LICENSED AS A REAL ESTATE BROKER, AND MAKES NO CLAIMS OR REPRESENTATIONS AS SUCH. EACH INDIVIDUAL PURCHASING SERVICES FROM ZEKES MOBILE NOTARY SERVICES IS ENCOURAGED TO SEEK COMPETENT LEGAL COUNSEL FROM AN ATTORNEY AND COMPETENT REAL ESTATE COUNSEL FROM A LICENSED REAL ESTATE BROKER.

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12) DISCLAIMER OF WARRANTY: TO THE MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW, THE SERVICE PROVIDED BY ZEKES MOBILE NOTARY SERVICES IS PROVIDED "AS IS" WITHOUT WARRANTIES, CONDITIONS, REPRESENTATIONS OR GUARANTIES OF ANY KIND, EITHER EXPRESSED, IMPLIED, STATUTORY OR OTHERWISE, INCLUDING BUT NOT LIMITED TO, ANY IMPLIED WARRANTIES OR CONDITIONS OF MERCHANTABILITY, SATISFACTORY QUALITY, TITLE, NON-INFRINGEMENT OR FITNESS FOR A PARTICULAR PURPOSE. ZEKES MOBILE NOTARY SERVICES DOES NOT WARRANT THE OPERATION OF ITS OFFERINGS WILL BE UNINTERRUPTED OR ERROR FREE. YOU BEAR THE ENTIRE RISK AS TO THE RESULTS, QUALITY AND PERFORMANCE OF THE SERVICE SHOULD THE SERVICE PROVE DEFECTIVE. NO ORAL OR WRITTEN INFORMATION OR ADVICE GIVEN BY ZEKES MOBILE NOTARY SERVICES AUTHORIZED REPRESENTATIVE SHALL CREATE A WARRANTY. THIS DISCLAIMER OF WARRANTY CONSTITUTES AN ESSENTIAL PART OF THE AGREEMENT.
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13) LIMITATION OF LIABILITY: TO THE MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW, IN NO EVENT AND UNDER NO LEGAL THEORY SHALL ZEKES MOBILE NOTARY SERVICES OR ANY OTHER PERSON WHO HAS BEEN INVOLVED IN THE CREATION, PRODUCTION, OR DELIVERY THE SERVICES IN THIS AGREEMENT BY OR ON BEHALF OF ZEKES MOBILE NOTARY SERVICES NOTARY SERVICES AND ITS OFFERINGS BE LIABLE TO YOU OR ANY OTHER PERSON FOR ANY GENERAL, DIRECT, INDIRECT, SPECIAL, INCIDENTAL, CONSEQUENTIAL, COVER OR OTHER DAMAGES OF ANY CHARACTER ARISING OUT OF THE LICENSING AGREEMENT OR THE USE OF OR INABILITY TO USE THE SERVICE, INCLUDING BUT NOT LIMITED TO, PERSONAL INJURY, LOSS OF DATA, LOSS OF PROFITS, LOSS OF ASSIGNMENTS, DATA OR OUTPUT FROM THE SERVICE BEING RENDERED INACCURATE, FAILURE OF THE ZEKES MOBILE NOTARY SERVICES NOTARY SERVICES SERVICE TO OPERATE WITH ANY OTHER PROGRAMS, SERVER DOWN TIME, DAMAGES FOR LOSS OF GOODWILL, BUSINESS INTERRUPTION, COMPUTER FAILURE OR MALFUNCTION, OR ANY AND ALL OTHER DAMAGES OR LOSSES OF WHATEVER NATURE, EVEN IF ZEKES MOBILE NOTARY SERVICES HAS BEEN INFORMED OF THE POSSIBILITY OF SUCH DAMAGES.
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I HAVE READ AND ACKNOWLEDGE THE PARAGRAPHS ABOVE. I AGREE TO HOLD ZEKES MOBILE NOTARY SERVICES HARMLESS FOR ANY AND ALL SERVICES PROVIDED AND HAVE BEEN GIVEN THE OPPORTUNITY TO SEEK COMPETENT LEGAL ADVICE FROM A LICENSED ATTORNEY AND COMPETENT REAL ESTATE ADVICE FROM A LICENSE REAL ESTATE BROKER.
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All information is held strictly private. I do not lend, sell, trade, or give away your private information to any vendor, person, or organization of any kind. I respect your privacy!
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NO REFUNDS OR PRORATED FOR NOTARY AND/OR PROCESS SERVICES RENDERED AND COMPLETED WITHIN A TIMELY MANNER AND OR FOR ANY DEPOSITS PAID TO HOLD A DATE AND FOR TIME FOR ALL PROFESSIONAL SERVICES PROVIDED IN GOOD FAITH.

IF IT IS FOUND THAT I MADE AN HONEST MISTAKE, I WILL REDO YOUR NOTARY/PROCESS SERVICE FOR FREE.

A STATE ISSUED PHOTO I.D. AND THUMB PRINT IS REQUIRED FROM ALL SIGNERS.

83) Todays Date:

MonthDayYear
84) Your Signature

Clear
85) Inmates Signature: ____________________________________

86) Date: ____________________
Should be Empty: