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
-- Select One -3. Gender 4. Last Name 5. First Name 6. Middle Name
Male
Female
8. City 9. Zip Code 10. Home Phone
7. Residential Address (street/route)
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) Filing Fee: $30.00 (make checks payable to "Secretary of State") Return application and filing fee to:
_____________________________
Date
Notary Officer Secretary of State's Office State Capitol Building, 200 West 24th Street Cheyenne, WY 82002-0020 Ph. 307.777.5335