NOTARY PUBLIC APPLICATION
IDENTIFICATION NUMBER
 COMMISSION DATE
 EXPIRATION DATE
NEW
 RENEWAL
STATE OF NEW JERSEY
DEPARTMENT OF THE TREASURY
DIVISION OF REVENUE
NOTARY PUBLIC APPLICATION
PHONE (609)292-9292 		8) YOUR COUNTY OF RESIDENCE
MORRIS
 9) YOUR DATE OF BIRTH
 
IMPORTANT: PLEASE READ INSTRUCTIONS. RENEWAL AND NEW APPLICANTS MUST ANSWER EVERY QUESTION (1-11). COMPLETE ALL ITEMS ON THIS FORM AND HAVE THE APPLICATIONS SIGNED BY A STATE LEGISLATOR.
1) HAVE YOU EVER BEEN CONVICTED OF A CRIME?
   (IF YES, ENCLOSE A STATEMENT OF DETAILS.) 		YES NO
2) HAVE YOU EVER BEEN A NOTARY PUBLIC IN NEW JERSEY?
   IF YES, UNDER NAME OF    		YES NO
3) EXPIRATION DATE OF PRESENT COMMISSION.
   (IF APPLICABLE)		 CURRENT
COMMISSION NO.
4) HAS YOUR COMMISSION EVER BEEN DENIED, SUSPENDED OR REVOKED?
   (IF YES, ENCLOSE A STATEMENT OF DETAILS) 		YES NO
5) SET FORTH YOUR OCCUPATION
    		FULL LEGAL NAME
   
6) SIGNATURE STREET ADDRESS
   
7) DATE
   
CITY
   		 STATE
     ZIP CODE
RENEWALS ONLY NON-RESIDENTS ONLY
PLEASE LIST BELOW ANY CHANGES SINCE YOUR PREVIOUS APPOINTMENT AS A NOTARY PLEASE LIST NEW JERSEY
BUSINESS NAME AND ADDRESS
BUSINESS NAME
STREET ADDRESS
CITY, COUNTY, STATE, ZIP CODE