ࡱ> _ bjbjuu 0b0b!^^***$NNNPb\N3TF!:!!!1**D*$^S`S`S`S`S`S`S$yV/YSi*#+*"1*#+#+S!!'S-1-1-1#+8!*!^S-1#+^S-1-1FH!r+VGJST03TnGYE,Y0HHY*H #+#+-1#+#+#+#+#+SS.>#+#+#+3T#+#+#+#+Y#+#+#+#+#+#+#+#+#+^B : Form 2301-NBGeneral Information (Application for Appointment as Texas Notary PublicNo Bond) (FOR STATE EMPLOYEES ONLY) The attached form is designed to meet minimal statutory filing requirements pursuant to the relevant code provisions. This form and the information provided are not substitutes for the advice and services of an attorney. Commentary Notaries Public are governed primarily by Chapter 406 of the Texas Government Code, Chapter 121 of the Texas Civil Practice & Remedies Code, and the Office of the Secretary of States administrative rules found in Title 1, Chapter 87 of the Texas Administrative Code. Section 406.005 of the Government Code sets forth the requirements for a notary public application. Notary commissions are effective as of the date of qualification by the applicant. The commission expires four years from the date of issuance and may be renewed by filing an application for renewal no earlier than 90 days before the date the commission expires. This form is required for both new and renewed applications by employees of state agencies. Notaries employed by state agencies, as that term is defined in section 2052.101, Texas Government Code, are not required to obtain surety bonds; however, they must obtain verification of employment from the State Office of Risk Management ( HYPERLINK "https://www.sorm.state.tx.us/insurance-program/notary-without-bond-forms-for-texas-client-agencies" SORM) prior to submitting their applications. These notaries must also purchase an official notary seal, stating that the notary is without bond, and record book. If you cease to be employed by a state agency during the term of your notary public commission, you must either surrender your commission or obtain a bond for the remainder of the term. Instructions for Form Identifying Information: You must enter your name exactly as you intend to sign documents as a notary public. Your commission will be issued in the name on the application. The disclosure of your social security number is mandatory under Section 406.005(a), Government Code. Tex. Govt Code Chapter 406. It will be used only to maintain the accuracy of the Office of the Secretary of States records. The Office of the Secretary of State will redact the social security number prior to providing a copy of this form in response to a public information request and will disclose the number only when required by law. A document on file with the Office of the Secretary of State is a public record subject to public access and disclosure. When providing address information, use a business or post office box address rather than a residence if privacy concerns are an issue. The agency address provided must be a state of Texas employers address. Provide your email address for electronic return of your commission and you will not receive your commission by mail. Qualifying Information: By signing the application, the applicant swears to meeting the qualification requirements for the office of notary public. A notary public must be at least 18 years of age, a legal resident of Texas, and meet the criminal history requirements of 406.004, Texas Government Code. When reporting criminal history on this form, you must disclose findings of guilt from any jurisdiction, including state and federal courts, military tribunals, and jurisdictions outside the U.S., regardless of whether the case has been appealed. Class C misdemeanors need not be disclosed. If you are unsure of the class of a crime or whether you were found guilty, disclose the crime and explain the circumstances. Applications are subject to background investigations. If a background investigation reveals any crimes (other than a Class C misdemeanor) that you failed to disclose on your application, denial or revocation of your notary commission may result. State Office of Risk Management Verification: An authorized person for the State Office of Risk Management must verify the applicants state employment by signing in the space provided. Attachments: The following items must be included with the application: (1) attachments regarding criminal convictions, if any; and (2) filing fee of $11. Payment and Delivery Instructions: The filing fee for a new or renewal application for commission as a Texas notary public is $11. Fees may be paid by interagency transfer voucher (ITV) or an agency/university check. Personal checks are not accepted. Agency/university checks must be payable to the secretary of state. If payment is being remitted by ITV, a copy of the ITV, including the applicants name in the USAS transaction description, must be submitted with the application. A copy of the agencys in house purchase order is not an acceptable substitute for the ITV with USAS transaction description. The completed application and filing fee must be submitted to the State Office of Risk Management, (512) 936-2927, Bonds and Insurance Section, P. O. Box 13777, Austin, Texas 78711-3777. The State Office of Risk Management will forward verified applications, along with the filing fees, to the Office of the Secretary of State. The Office of the Secretary of State will issue a notary commission upon filing of a completed, qualified application. Form #2301-NB Rev. 10/2018 Submit to: STATE OFFICE OF RISK MANAGEMENT Bonds & Insurance Section P O Box 13777 Austin, TX 78711-3777 notary@sorm.texas.gov Filing Fee: $11 APPLICATION FOR APPOINTMENT AS TEXAS NOTARY PUBLICNO BOND This space reserved for office useIdentifying InformationName to be used as notary public: FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT     Social Security No.:LastFirstMiddle (optional)Suffix FORMTEXT    - FORMTEXT   - FORMTEXT     Mailing Address: FORMTEXT       FORMTEXT      TX FORMTEXT      Residence County:StreetCityStateZip FORMTEXT      Agency Address: FORMTEXT       FORMTEXT      TX FORMTEXT      StreetCityStateZipEmail address for return of commission (print legibly) FORMTEXT       Date of Birth: FORMTEXT   / FORMTEXT   / FORMTEXT      Driver s License or Identification No.: FORMTEXT      Issuing State: FORMTEXT   Statements Relating To QualificationI, the above-named applicant, have never been convicted of a felony or crime involving moral turpitude, am at least 18 years of age and a legal resident of Texas. {All applications are subject to a background check.}  FORMCHECKBOX  A.I have been found guilty of a crime other than a Class C misdemeanor. (Applicants selecting this option must attach the following for each crime: (1) copies of court order and sentence, and papers pertaining to release from probation; and (2) a statement of (i) the nature, circumstances, date, and location, and (ii) whether the case is on appeal.) {A conviction for a crime involving moral turpitude OR a FELONY disqualifies you from appointment as a notary public under Texas law.}  FORMCHECKBOX  B.I have never been found guilty of a crime OR I have only been found guilty of a Class C misdemeanor, e.g. minor traffic violations such as speeding.State Office of Risk Management VerificationTHE STATE OFFICE OF RISK MANAGEMENT (SORM) VERIFIES THAT: The above-named applicant, an employee of FORMTEXT       FORMTEXT      , is authorized to be commissionedAgency NameCode Numberas a Texas notary public pursuant to 653.012,Texas Government Code, without providing a notary public surety bond.Date: FORMTEXT      Signature of authorized person for SORM FORMTEXT      Printed or typed name of authorized person for SORMStatement of OfficerI,the above-named applicant, do solemnly swear (or affirm) that I have not directly or indirectly    !#3>U]^_yzV X d  񝑂rbrSDhlha/CJOJQJaJhlhs-CJOJQJaJhlh26CJOJQJaJhlh25CJOJQJaJhHoFh2CJOJQJaJhHoFCJOJQJaJh2CJOJQJaJhlhYCJOJQJaJhlhKCJOJQJaJhj3>CJOJQJaJhlhZBCJOJQJaJhlhsCJOJQJaJhlh2CJOJQJaJ"_zW X Y d > ? ~vmmm $@&a$gd $a$gd $a$gd2\kd$$Ifl    `'`'0    4 lalytO $$Ifa$gdO$a$gdHoF$a$gd2  ' . 8 @ A E J K x     * 9 : < = ӴteVhlhM0CJOJQJaJhlhaCJOJQJaJhlh6CJOJQJaJhlha6CJOJQJaJhlh;~#6CJOJQJaJhlhs6CJOJQJaJhlhcl6CJOJQJaJhlhclCJOJQJaJhlh`;CJOJQJaJhlhsCJOJQJaJhlh CJOJQJaJ= > ? / 1 2 678IӵuӵfVFhlh;~#6CJOJQJaJhlhc6CJOJQJaJhlh;~#CJOJQJaJ hj:Shc0J(CJOJQJaJ%jhj:SCJOJQJUaJhj:SCJOJQJaJjhj:SCJOJQJUaJhlhcCJOJQJaJhlhCJOJQJaJhlhCJOJQJaJhlh$CJOJQJaJhlh_tCJOJQJaJ? {$z&`#$/Ifgdl&$ 8`0p@ P !$`'0**$a$gdl*$ 8`0p@ P !$`'0**$^a$gd~$a$gdl$a$gd5 $@&a$gdl $@&a$gd%23BF/0NPuufuWuHuHuHuhlha/CJOJQJaJhlhm\CJOJQJaJhlh_8CJOJQJaJhlh~CJOJQJaJhlhUCJOJQJaJhlh3CJOJQJaJhlhCJOJQJaJhlh-v5CJOJQJaJhlh5CJOJQJaJhlhe|5CJOJQJaJhlhl5CJOJQJaJhlhzCJOJQJaJPLMNf.~'_ôӆwhwYhJw7w%hlh.6B*CJOJQJaJph# hlhACJOJQJaJhlhiBCJOJQJaJhlh 1CJOJQJaJhlh.6CJOJQJaJhlhK5CJOJQJaJhlha/CJOJQJaJhlhCJOJQJaJhlh)cCJOJQJaJ *hlhUCJOJQJaJhlhlCJOJQJaJhlh~CJOJQJaJhlhuCJOJQJaJMN&{sgs[O $7$8$H$a$gdl $h^ha$gd.6 $^a$gd$a$gdlh^hgdUzkd$$Ifl`'' t 6`z0'644 lap yta_&' vw_%$ 5`0p@ P !$`'0**$a$gdl%$ 5`0p@ P !$`'0**$a$gdwQ%$ 5`0p@ P !$`'0**$a$gdl$a$gdN( $h^ha$gdQ?h^hgdy/f$a$gdl $7$8$H$a$gd.6 _ N"#(=Y^dǷxiYiI::hlhCJOJQJaJhlh.65CJOJQJaJhlhC6CJOJQJaJhlhCCJOJQJaJhlhC5CJOJQJaJhlhQ?5CJOJQJaJhlhwQCJOJQJaJhlhwQ5CJOJQJaJhlhy/f5CJOJQJaJhlh.6CJOJQJaJ(hlhu6B*CJOJQJaJph# (hlh.66B*CJOJQJaJph# dsw!@P&-Iôyjj[Oh;CJOJQJaJhlhI<CJOJQJaJhlha/CJOJQJaJhdCJOJQJaJhlhwQ6CJOJQJaJhlhuCJOJQJaJhlhwQ5CJOJQJaJhlhwQCJOJQJaJhlhsCJOJQJaJhlh-v5CJOJQJaJhlhCCJOJQJaJhlh)cCJOJQJaJ+AQT$ $*$Ifa$gd& $$Ifa$gd& $*$Ifgd& $IfgdO $IfgdOgdl+@PQRTdo㪘wdVH:Hh8kwhK5@OJQJh8kwhs5@OJQJh&h@y5@OJQJ$jhh&h8kw5@OJQJUh:X5@CJOJQJaJ#h8kwhZB5@CJOJQJaJ#h8kwh@y5@CJOJQJaJh@yhd5CJOJQJh&hZB5CJOJQJh&hs5CJOJQJh&h \5CJOJQJh&h@y5CJOJQJhj3hlCJOJQJaJ  $&(24ŷsk\sJssk;sJsj5h?OJQJU"jh?OJQJUmHnHujh?OJQJUh?OJQJjh?OJQJUh&hJOJQJh&hFCJOJQJaJh]hFCJOJQJaJh]hxmCJOJQJaJh&h@y5@OJQJh8kwh@y5@OJQJh8kwhZB5@OJQJhehY5>*@OJQJh8kwhY5@OJQJs-Fkd$$IfT`'`' t`'4ap yt&T$ P$*$Ifa$gd&xkd5$$IfTF |`'   t`'    4apyt]T6^ $*$Ifgd&=VHkda$$IfTD`'`' t`'4ap yt,AT $*$Ifgd& 468LNPZ\^`tvx "yqbyPy"jh?OJQJUmHnHujgh?OJQJUh?OJQJjh?OJQJUh]6CJOJQJaJh&h\<6CJOJQJaJh&h\<CJOJQJaJj h?OJQJU"jh?OJQJUmHnHujh?OJQJUh?OJQJjh?OJQJUh&hJOJQJ' $*$Ifgd&kds$$IfT4֞ `'`. 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I further certify that the information provided in and with this Application is true and correct and that I am not disqualified by law or any other reason from holding the office of notary public. Date: FORMTEXT      Signature of Applicant (sign in name given above on line #1 to be used as notary public)  DEFGQR@$ $*$Ifa$gd&FkdB$$IfT`'`' t`'4ap yt&T $*$Ifgd&FkdhB$$IfT`'`' t`'4ap yt&T$ $*$Ifa$gd&EGQRST^ϾygUF5 h&h!r@CJOJQJaJh&h!rCJOJQJaJ#h&hl6@CJOJQJaJ#h&hJ6@CJOJQJaJ#h&h1Z6@CJOJQJaJ#h&hN6@CJOJQJaJ#h&h!r6@CJOJQJaJh&h!rCJOJQJaJ h&h!r@CJOJQJaJh&hn\5CJOJQJaJ#h&hn\5@CJOJQJaJh&hPCJOJQJaJQRS $*$Ifgd&mkd C$$IfT`'`' t0`'4ap yt&TST$ $*$Ifa$gd&mkdC$$IfT`'`' t0`'4ap yt&T $*$Ifgd&mkdZD$$IfT`'`' t0`'4ap yt&T68: $*$Ifgd&mkdD$$IfT`'`' t0`'4ap yt&T$&(24:<Bpr̻֧䜍reUrH=hYFhUCJaJh&hn\OJQJaJhvhi-56@OJQJhi-56@OJQJhvhi-5@OJQJhbhi-@OJQJh&hn\@OJQJaJh&hn\OJQJ&jh?@OJQJUmHnHu!jEh?@OJQJUh?@OJQJjh?@OJQJUh&hn\@OJQJh&h!rCJOJQJaJ:<>@BH9999 $*$Ifgd&kd F$$IfT\P `':J t0`'4ap(yti-TH><<<< F*$gdYkdUG$$IfT\P `':J t0`'4ap(yti-T #ghijpqrst}дéyly]ylUhdOJQJhxW0J&OJQJmHnHuh`NhW0J&OJQJ!jh`NhW0J&OJQJUhWh -hWCJOJQJaJhWCJOJQJaJhhWOJQJhW0J&OJQJmHnHuhhW0J&OJQJ!jhhW0J&OJQJU hL%CJUjhL%UhL%jhL%CJU PAGE 2 Form 2301-NB Questions may be directed to the Notary Public Unit at 512-463-5705. 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