Affirmation for Appointment and Commission as a Notary Public
INSTRUCTIONS FOR COMPLETION
Make sure you are using the most recent form. If this is not the most recent form, the
Department of State will be unable to process any portion of your application.
If you are registering to become or renewing a notary commission, you will be referred to
as “Applicant”. If you are notarizing the affirmation, you will be referred to as “Notary”.
Applicant: The person registering or renewing a notary commission.
1. Type your name as it appears on your government issued identification. (Ex:
driver’s license)
Note: Your middle name or suffix
is optional.
Print Affirmation and go to a current
notary with commission issued by the
State of Colorado.
2. In front of a notary, sign the
affirmation using your official
signature. This is the
signature that is kept on file
and will be used to
authenticate the documents
you have notarized.
Notary: Individual with a current notary
commission issued buy the state of
Colorado. Failure to correctly notarize
this document may be grounds for
admonishment.
3. Write the county where the notarization is taking place
4. Write today’s Day and Month
5. Write today’s Year
6. Write the name of the applicant that signed the document.
7. Sign the affirmation using your official signature.
8. Write your RULONA Title. This must be one of the following:
a. Notary Public
b. Clerk
c. Deputy Clerk.
d. Judge.
9. Stamp the document ensuring the stamp is completely in the white space at the
bottom.
10. Complete a journal entry for this notarization.
Affirm
Rev. 06/21/2024 Page 1 of 2
Affirmation for Appointment and Commission as a Notary Public
Applicant
I, , solemnly affirm, under the
Type the name as it appears on your ID (middle name optional)
penalty of perjury in the second degree, as defined in section 18-8-503, Colorado
Revised Statutes, that I have carefully read the notary law of this state, and if
appointed and commissioned as a notary public, I will faithfully perform, to the best of
my ability, all notarial acts in conformance with the law.
I understand that this sworn statement is required by law because I have
applied for a public benefit. I understand that state law requires me to provide proof
that I am lawfully present in the United States prior to receipt of this public benefit. I
further acknowledge that knowingly making a false, fictitious, or fraudulent statement
or representation in this sworn affidavit is punishable under the criminal laws of
Colorado as perjury in the second degree under section 18-8-503, Colorado Revised
Statutes, and it shall constitute a separate criminal offence each time a public benefit
is received based on such statement or representation.
Applicant’s official signature (must sign in front of notary)
Notary
State of Colorado
County of
Signed and sworn to [or affirmed] before me on , 20
By (name of individual making statement)
Notary’s official signature (Stamp)
Title (Notary Public, Clerk)
Affirm
Rev. 06/21/2024 Page 2 of 2
