State of Missouri
John R. Ashcroft, Secretary of State
Commissions
PO Box 784, Jefferson City, MO 65102
Toll-Free (866) 223-6535 or (573) 751-2783
Application for Commission as a Notary Public
(Application fee $25)
Print or Type
1. Name Date of Birth (MM/DD/YYYY)
(This name must appear as it is signed in #18 below)
2. Home Address
City State Zip Code
3. County of Residence or place of regular business (St. Louis City Residents, please specify St. Louis City)
4. Daytime Phone Number Email Address
5. Employer/Name of Business
Street
City State Zip Code
6. Missouri Commission Number (if reapplying)
7. Previous Commission Expiration Date (if any)
8. Previous Name (if your name has changed)
Check YES or NO for the following questions:
9. Are you at least eighteen years of age? YES NO
10. Are you able to read and write the English language? YES NO
11. Do you reside legally in the United States? (Section 245, Immigration and Nationality Act requires that you, attach a YES NO
copy of your green card)
12. Do you live or work in the county within and for which you have requested to be commisioned? YES NO
13. In the last five years have you been denied, revoked, suspended, restricted or resigned a notorial commission, professional YES NO
license, or public office in this or any other state or nation? (If yes, attach a separate letter indicating reason and date.)
14. In the last five years have you ever been convicted of or pled guilty or nolo contendere to any felony in this or any other YES NO
state or nation? (If yes, attach a list and supporting documentation of such convictions or pleas of guilt or nolo contendere.)
15. Do you have claims pending or disposed against your notary bond held or any civil findings or admissions of fault or YES NO
liability regarding your activities as a notary in this or any other state or nation?
(If yes, attach a list and supporting documentation of such.)
16. Have you read the Missouri Notary Public Handbook and know the laws and duties of a Notary Public? YES NO
17. Have you completed a state-approved notary training? (Attach your certificate of completion or your YES NO
completed written notary training form.)
18. Declaration of Applicant
STATE OF MISSOURI
I, ____________________ (name of applicant), do solemnly swear or affirm under penalty of perjury that the personal information in this application is true, complete,
and correct; that I understand the official duties and responsibilities of a Notary Public in Missouri, as explained in the notary public handbook; and that I will perform,
to the best of my ability, all notorial acts in accordance with the law.
X
Signature of Applicant (Signature MUST appear as it is typed or written in #1 above)
Form Comm. 51 (07/2024) — Page 1 of 2
PAYMENT
$25 Check or Money Order Enclosed (Payable to Secretary of State’s Office) *Credit Card: Master Card Visa Discover American Express
*($1.25 convenience fee will apply)
NAME AS IT APPEARS ON CREDIT CARD
EXPIRATION DATE CARD NUMBER (16 Digits)
CVV—SECURITY CODE FROM BACK OF CARD
BILLING ADDRESS FOR CARD WITH CORRECT ZIP CODE
SIGNATURE
Application Instructions
1. Name – Print or type your name as you want it to appear on your commission certificate. You are required by law to use your
full last name, while initials may be used for first and middle names.
Date of Birth – Please provide your birth date in numerals: month/day/year. This is to confirm that applicants are at least 18
years of age.
2. Home Address – Please provide the address at which you reside. If your mail goes to a post office box, please include a street
address after the PO Box number. Also give the city, state and zip code.
3. County of Residence or Place of Regular Business – Please indicate the county in which you legally reside or place of regular
business. You are commissioned for the county in which you live or where your regular place of business is located. You are
able to notarize anywhere in the state of Missouri as a Missouri resident. If you reside in St. Louis City, please put St. Louis City
in the county blank.
4. Daytime Phone Number – You are requested to provide a phone number where we can reach you BETWEEN THE HOURS
OF 8:00 a.m. and 5:00 p.m., should we need to verify information given on the application.
Email Address – Please provide your email address.
5. Employer / Name of Business – Your employer’s name is requested should we need to contact you during working hours. If
unemployed, please enter “N/A” or enter “Self-employed” if you own your own business.
6. Missouri Commission Number – If reapplying, please provide your Missouri commission number.
7. Previous Commission Expiration Date – Please provide if reapplying.
8. Previous Name – If your name has changed since your last commission, please provide your previous name.
9-17. Yes or No – Please READ CAREFULLY AND ANSWER CORRECTLY the nine questions listed on this portion of the appli-
cation.
18. Notarial Oath – Complete the form by signing your name in the same name style you indicated in #1 on the application affirming
that the information provided is true and complete.
REQUIRED ENCLOSURES:
$25 application fee as required under Sections 486.630 and 28.160.3
RSMo
Certificate of state approved notary training or completed written
notary training form.
FORM MUST BE SIGNED UNDER
OATH ON FRONT PAGE
Form Comm. 51 (07/2024) — Page 2 of 2
