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Wyoming Notary Public Commission Application
(W.S. 32-1-107)
Instructions: Fill in all blanks, using "NA" if not applicable. Type or print clearly.
1. Commission Name Style (type or print name to exactly match signature below.) 2. County of Residence
3. Gender 4. Last Name 5. First Name 6. Middle Name
Male Female
7. Residential Address (street/route) 8. City 9. Zip Code 10. Home Phone
11. Mailing Address (where notary information will be mailed) 12. City 13. Zip Code
14. Place of Employment (name & address) 15. City 16. Zip Code 17. Business Phone
18. I am applying for:
a new commission; or
a renewal of my current commission. My current commission expiration date is: ___________________
19. Have you ever been a Wyoming notary?
Yes, under the name of ______________________________ in ________________________ County.
No.
Certification: please read, sign, and date.
I certify that I am 18 years of age or older, able to read and write the English language, and an actual
resident of the state of Wyoming and of the County for which I am making application.
I further certify that I understand the duties and responsibilities imposed on notaries public under
Wyoming law and understand that breach of said responsibility may result in criminal penalties including
imprisonment.
_______________________________________ _____________________________
Signature of applicant (must match item #1 above) Date
Filing Fee: $30.00 (make checks payable t "Secretary of State")
Return application and filing fee to:
Notary Officer
Secretary of State's Office
State Capitol Building, 200 West 24th Street
Cheyenne, WY 82002-0020
Ph. 307.777.5335