Free Notary Complaint Form - Indiana

Indiana Secretary of State Todd Rokita

Notary Desk
201 Statehouse; 200 West Washington Street

Indianapolis, Indiana 46204

Notary Complaint Form Personal Information of Complainant Name:_______________________________________ Home Address:__________________________________________________________________________________ Home Phone Number:_________________________ Business Address:__________________________________________________________________________ Business Phone Number:______________________ What is the conduct that serves for the basis of the complaint?____________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ What relief are you requesting?______________________________________________________________ Notary Public Information Name:______________________________________ Address:__________________________________________________________________________________ Phone:_____________________________________ Date of expiration of notary commission:_______________________________________________________ Please attach copies of the following: Documents Notarized by the notary in question Any correspondence relating to the above I hereby verify, subject to penalties of perjury, that I have read the information contained in and attached to this complaint and that all of the information I have given is accurate and complete to the best of my knowledge and belief. SIGNATURE______________________________________ DATE_________________________________ PRINTED NAME__________________________________