Free 28800&28.PDF - Indiana

NOTICE OF ADDRESS CHANGE WITHIN ORIGINAL COUNTY OF RESIDENCE
State Form 28802 (R3 / 7-96) Please Type or Print

INSTRUCTIONS: There is no fee for recording this form. Complete and return to the Secretary of State, Notary Department, Room 201, State House, Indianapolis, Indiana 46204. Expiration Date:
County of residence City City New business telephone number Signature ZIP code ZIP code

Commission Number:
Name in which commission was issued Old residence address (street or rural route) New residence address (street or rural route) New home telephone number

19

State of Indiana

)

County of _________________________________ )

SS

Before me the undersigned, an officer authorized to take acknowledgements, (Notary Public, Clerk of the Circuit Court, etc.) personally appeared ____________________________________________________________ and acknowledged the execution of the foregoing instrument this _________ day of ____________________________, 19 ______. IN WITNESS WHEREOF, I _________________________________________________, have hereunto set my hand and official seal this __________
Printed or typed name

day of _____________________________, 19 _______. ______________________________________________________, a _____________________________________________________ for the County
Signature of Notary Public or other authorized officer Type of office

of ___________________________________________ . My commission expires ____________________________________.

NOTICE OF TERMINATION OF NOTARY PUBLIC COMMISSION
To be issued when a Notary moves out of state, accepts another lucrative public office, resigns or ceases to be a Notary Public for any other reason.
State Form 28800 (R3 / 7-96)

INSTRUCTIONS: There is no fee for filing this form. Complete and return to the Secretary of State, Notary Department, Room 201, State House, Indianapolis, Indiana 46204. Commission Number:
Name in which commission was issued Reason for termination

Expiration Date:
County of residence Signature

19

State of Indiana

)

County of _________________________________ )

SS

Before me the undersigned, an officer authorized to take acknowledgements, (Notary Public, Clerk of the Circuit Court, etc.) personally appeared ____________________________________________________________ and acknowledged the execution of the foregoing instrument this _________ day of ____________________________, 19 ______. IN WITNESS WHEREOF, I _________________________________________________, have hereunto set my hand and official seal this __________
Printed or typed name

day of _____________________________, 19 _______. ______________________________________________________, a _____________________________________________________ for the County
Signature of Notary Public or other authorized officer Type of office

of ___________________________________________ . My commission expires ____________________________________.