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 ID: 19622
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REASURYIVISION OF ERVICESPPLICATION292-9292 Important: Please read instructions on reverse side. Complete lines 1 8. New Jersey Non-Residents also complete line 9. Lines 10 and 11 must be completed by State Legislator. Application typeRenewal (Please enter the following information from your current commission certificate) Commission Number Expiration Date Print Name Name Change/ Correction (First Name) (M.I.) (Last Name) Home Address Address Change/ Correction (Number and Street, including apartment number and rural route) City/Town County Date of Birth Has your commission ever been denied, suspended or revoked?No (If yes, enclose a statement of details) Have you ever been convicted of a crime?No (If yes, enclose a statement of details) New Jersey Non-Residents Only Please list New Jersey Business Name and Address Business Name Business Address (Number and Street, including apartment number and rural route) City/Town New Jersey County Signature of State Legislator Legislative District Number For internal use only APPLICATIONservesimpartialwitnessthedocuments,attestssignaturetheandadministeroathsandTreasureryearperiod.notarypublicattorneynotadvertisethetitlelawyerattorneylaw.advertisesservicesstatementnotattorneypracticegivelegalaboutotherlegalacceptadvice.PREREQUISITESPUBLICNewmaintains,employedNewandcrimeundertheStateFederalGovernment,offensedishonesty,degree.APPLYINGNOTARYPUBLICtheNewRevenueEnterprisewebsitehttp://www.state.nj.us/treasury/revenue/for applicationappropriateinformation   Notaryyourmakecheckbox(es)linesbusinessemploymentNewlineattachapplicationattestingaddress.ReceiveendorsementfrommembertheNew   completedendorsedpaperapplicationcheck$25.00(nonrefundable)08646.checkJersey.   applicationproperlycompleted,willNotarytogetherQualificationCertificatewithinPublicCertificateOathCertificatethe(foremployedNewJersey)yourequiredperschedule.QualificationCertificate   Certificatesubmitted whereyouhappens,letterabout completeapplicationprocess.addition,willcancelPublicCertificate.   maintainsdatabasehttp://www.state.nj.us/treasury/revenue/notary.shtml